SURYA SEN MAHAVIDYALAYA

ISO 9001:2015 & ISO 21001:2018

Siliguri :: Dist - Jalpaiguri :: West Bengal
Application form for admission in FOUR YEAR UNDERGRADUATE PROGRAM :: Session : 2023-24

Application Form No. : 23 / 72657 Application Date : 14-07-2023

Applicant's name : PALLAB DEBNATH Caste/Category : OBC-B
Father's Name : PROBIR DEBNATH Mob No.: 7469815507 Occupation : Others
Mother's Name : BEUTI DEBNATH Mob No.: 9832380545 Occupation : House Wife Applicant's photo
Guardian's Name : PROBIR DEBNATH Mob No.: 7469815507 Occupation : Others
Family Income (Yearly) : 100000 Date of Birth: 24-06-2005 Marital Status : Un-Married
Relation with Guardian : FATHER Blood Group: O+ Sex : MALE
Father's Edu.Qualification : 8 TH Mother's Edu.Qualification: 8 TH
Permanent Address : Corresponding Address :
KAWAKHALI KAWAKHALI
P.O.:SUSHRUTA NAGAR, P.S.: MATIGARA P.O.:SUSHRUTA NAGAR, P.S.: MATIGARA
Block/Muni./Corp.: MATIGARA, Dist.: DARJEELING Block/Muni./Corp.: MATIGARA, Dist.: DARJEELING
State: WEST BENGAL, INDIA, PIN : 734012 State: WEST BENGAL, INDIA, PIN : 734012
Nationality : INDIAN Religion : HINDUISM
Minority : NO Physically Challenged : NO
BPL : NO Aadhaar Card Number : 704282784014
Applicant's Mobile Number : 8436967643 Email : rahuldebnath8194@gmail.com
Board / Council in 10+2 Exam. : WBCHSE Guardian Email: rahuldebnath8194@gmail.com
Year of passing : 2022 Roll : 110411 No. : 1445
Institution Last Attended : RANIDANGA KALARAM
Address
HIGHofSCHOOL
the Institution: RANIDANGA
Medium : BENGALI Do you have Bangla Shhiksha Student-ID: NO Bangla Shhiksha Student-ID: NA
Marks Details in 10+2 Exam.: SUBJECT FULL MARKS MARK OBTAIN
ENGLISH 100 60
BENGALI 100 78
HISTORY 100 70
POLITICAL SCIENCE 100 53
GEOGRAPHY 100 60
PHILOSOPHY 100 62
1st Preference for Major, Minor & MDC Subject:
MAJOR : BENGALI MINOR 1 : HISTORY MINOR 2 : POLITICAL SCIENCE
MDC 1 : HISTORY OF NORTH BENG MDC 2 : TOURISM AND TRAVEL MAHAGEME MDC 3 : BASIC PROGRAMING
2nd Preference for Major, Minor & MDC Subject:
MAJOR: HISTORY MINOR 1 : BENGALI MINOR 2 : POLITICAL SCIENCE
MDC 1 : HISTORY OF NORTH BENG MDC 2 : TOURISM AND TRAVEL MAHAGEME MDC 3 : BASIC PROGRAMING
3rd Preference for Major, Minor & MDC Subject:
MAJOR: POLITICAL SCIENCE MINOR 1 : BENGALI MINOR 2 : ENGLISH
MDC 1 : HISTORY OF NORTH BENG MDC 2 : TOURISM AND TRAVEL MAHAGEME MDC 3 : BASIC PROGRAMING
SEC Courses : Three Skill Enhancement Courses (SEC) need to be complited based on MAJOR Courses.
Ability Enhancement Courses (AEC) : i) ENGLISH ii) BENGALI
Value Added Courses (VAC) : i) ENVIRONMENTAL EDUCATION ii) DIGITAL MARKETING
Interested to join NCC: NO Interested to join NSS: NO
Interested to join Certificate Course in Computer: NO Interested to join Certificate Course in Travel and Tourism Management Course: YES

Declaration : I do hereby declare that the details furnished above and the scanned copies of the documents uploaded, are true and correct to the best of
my knowledge. In case of any information/document found to be false or untrue, at a later stage, I am aware that my admission will be cancelled and
Admission Fee forfeited. The authority may initiate legal action in such cases.

Signature of the applicant with date