GURUCHARAN COLLEGE, SILCHAR
(ESTD.-1935)
College with Potential for Excellence
A-Grade Re-accredited by NAAC
APPLICATION FORM
for Admission to
Previous Class Roll No.: FYUG 2nd Year Semester III FOR OFFICE USE ONLY
2466102090
Science Roll No.:
SAMARTH Enrollment No.:
240147552 Session : 2025-26 Date of Admission:
Application Serial No.: 522506925
UID : U2403512757689 ABC ID : 432934535482
1. Name of Applicant : SHRAYA NATH
2a. Mobile No : 7896094380
2b. Alternate Mobile No : 8811820730
3. AADHAR Number : 397455999927
4a. Email ID : shrayanath16@gmail.com
4b. Alternate Email ID :
5a. Date of Birth : 20/02/2006 5b. Age as on 1st July : 17 YEARS 4 MONTH 12 DAYS
6a.Gender : Female 5b. Marital Status : Unmarried
7. Religion : Hinduism 9. Community : BENGALI
8. Caste / Category : OBC
9. Do You Want to Avail FEE WAIVER SCHEME of Assam Govt.: YES
10. Are you citizen of India : Yes
11. Nationality : INDIAN
12. Domicile : Assam
13. ID Proof : PAN Card
14. ID Proof No : CGXPN2476E
15. Other Category / Quota : a. Extra Curricular Activity : Not Applicable
b. Person with Benchmark (PWBD) Category : : Not Applicable
c. Are you from Tea Garden Community? : No
d. Are you Kashmiri Migrant? : Not Applicable
e. Prime Minister Special Scholarship for J&K Students : Not Applicable
f. Are you Ex-Serviceman ? : No
g. Are you descendant of freedom fighter? : No
h. Are you Single Girl Child ? : Yes
16. Address Details :
PERMANENT ADDRESS PRESENT ADDRESS
Address Line 1 LAKSHMISAHAR, WORD NO.14 LAKSHMISAHAR, WORD NO.14
Address Line 2 HAILAKANDI HAILAKANDI
Post Office HAILAKANDI HAILAKANDI
Police Station HAILAKANDI HAILAKANDI
District HAILAKANDI HAILAKANDI
State ASSAM ASSAM
PIN 788152 788152
Cluster Name HAILAKANDI HAILAKANDI
HAILAKANDI HAILAKANDI
Block Name
LAC Name HAILAKANDI
17. Family Information :
a. Mother's Name : LATE SHIBANI NATH
b. Father's Name : LATE SANJIT NATH
c. Local Guardian's Name : MANUJ KUMAR NATH
UID : U2403512757689 ABC ID : 432934535482
Qualification Occupation Office Address Phone No.
Father None Not Applicable
Mother None Not Applicable
d. Combined Family Income : 1,00,000 e. Emergency Contact No : 9365946113
18. University Registration Details :
a. Have you enrolled in University / Autonomous Colleges before: No
b. If Yes Enrollment No:
c. Name of University / Autonomous College:
d. Program registered with the University / Autonomous College:
e. In Case of any break of studies, the period and reasons thereof are to be stated: Period:
Reason:
f. Registration No. (If any): 20240031284 of: 2024
g. In Case of Transfer : Certificate No. Date :
Cause of Transfer
Permission Letter No. Date :
19. Academic Details
Name of Year of RollN Full Marks Division/
Examination Name of
Board/Council/ Subjects Grade
Institution Passing o. Marks Obtained
University Point/ %
Semester II AU GURUCHARAN ZOOLOGY DSC, CHEMISTRY DSM, 2025 022524 0
COLLEGE ANTHROPOLOGY IDC, ENGLISH
AEC, ZOOLOGY SEC, EVS VAC 020011723
Marks Details of Last Examination :
Zoology dsc 151 0.00 0.00
Zoology dsc 152 0.00 0.00
Chemistry dsm 151 0.00 0.00
Anthropology idc 151 0.00 0.00
Zoology sec 151 0.00 0.00
English aec 151 0.00 0.00
Evs vac 151 0.00 0.00
20. Subjects Preferred :
Pref DSC 201 DSM 201 DSM 202 IDC 201 SEC 201 AEC 201
1 Zoology Alt. English
Zoology Botany Chemistry Anthropology
21. Other Details : a. Do you have any illness which require continuous or emeregency medical attention: No
b. Do you belong to Moran Community of Assam: No
c. Do you belong to fringe village of Assam: No
d. Area of Residence Urban
e. Are you Son / Daughter of Present Employee of college No
f. Are you Son / Daughter of Ex - Employee of college No
g. Do you have migration certificate No
h. Do you have transfer certificate from school / college No
i. Candidate havinf NCC 'B' 'C' certificate No
j. Have You attended any special camp under NSS No
UID : U2403512757689 ABC ID : 432934535482
22. Bank Details : Bank Name : STATE BANK OF INDIA, HAILAKANDI
Account Number : 7333026033781 IFSC Code : UTBIORRBAGB
23. Blood Group : A+
24. Whether willing to stay in the Hostel: NO
25. Have you applied in some other colleges?: NO Kg
26. Mother Tongue : BENGALI Height: 160 Cm Weight: 54
27. DECLARATION BY THE APPLICANT :
I do hereby declare that
i. ... the above particulars submitted by me are correct to the best of my knowledge and belief
ii. ... I shall abide by the rules and regulations of the college failing which the college authority may take any step which it
deems fit and proper.
iii. ... I shall do nothing in or outside the college that may impair the discipline, good name and honour of the college.
iv. ... I shall attend the classes regularly and secure attendance of not less than 75% in each subject as stipulated by Assam Higher
Secondary Education Council / Assam University. I am fully aware that attendance of less than 75% in any of the subjects will
debar me from appearing in the University Examinations.
v. ... I shall appear in all internal assessments and tests conducted by the college and secure more than the minimum
prescribed marks in each subject.
vi. ... I will conform to the uniform and dress code in its entirety prescribed by the college.
vii. ... I will not use Mobile Phone inside the college campus.
viii. ... I will neither indulge in nor provoke any ragging inside or outside the campus. I am fully aware that involving in
ragging is an offence and punishable as per law.
If any of the above statements or information is found to be incorrect or if my conduct/ attendance/ result is not satisfactory, my
admission is liable to be cancelled and I shall have no claim to continue as student of this college.
(Signature in full of Father/Mother/Guardian) (Signature in full of the Candidate)
09/07/25 09/07/25
Date: .................................. Date: ..................................
FOR OFFICE USE ONLY
DSC 201 DSM 201 DSM 202 IDC 201 SEC 201 AEC 201
Subjects
Recommended
Admission Fee : Rs. 0.00
Convenor, Admission Committe
Dealing Assistant (ADMISSION)
Cashier's Report Principal's Report
Received ₹ ..................................................... Admit Provisionally
Receipt No. ....................Date ........................
Principal
Signature of Cashier ........................................
LIST OF ENCLOSURES
Attested Photocopies of :
1. Admit Card of HSLC or equivalent examination.
2. Marksheet of Last Passed Examination.
3. Fee Card of Last Academic Year (For Students of G C College only)
4. Pass / Character Certificate from the Head of the Institution last attended for admission into HS-1 / TDC-1
5. Admit Card and Marksheets of last TDC examinations (For TDC 3rd & 5th Sem.)
6. Caste Certificate (if any)
7. Sports / NCC / Scout Certificate (if any), Front Page of Bank Passbook, Domicile Proof
UID : U2403512757689 ABC ID : 432934535482
Submission of online forms with subject combination does not guarantee admission. Admission will be finalised by
Admission Committee alongwith subject combination on the date of merit list publication (for 1st Sem only)
UNDERTAKING FOR ATTENDENCE
I SHRAYA NATH do, hereby, give the
undertaking that I shall attend 75% of the classes failing which I will not
be allowed to fill up the forms of TDC/HS Final Examination conducted
Assam University, Silchar or Assam Higher Secondary Council, as the
case may be.
(Signature in full of Father/Mother/Guardian) (Signature in full of the Candidate)
Date: 09/07/25 Date: 09/07/25
CAUTION REGARDING RAGGING ACTIVITY
Any kind of involvement in ragging activity or giving indulgence to
such activity is a punishable offence as per the "UGC Regulations
on curving the menace of ragging in higher education institutions,
2009" notified on 4th July 2009 in the Gazette of India in persuance
to the judgement of the Hon'ble Supreme Court of India dated
08.05.2009 consequent upon Civil Appeal No. 887/2009.
Admission Fee : Rs. 0.00
Application Serial No.: 522506925
Name of Applicant.: SHRAYA NATH
Class and Sem: FYUG 2nd Year Semester III
Stream: Science
