APPLICATION FOR ADMISSION TO THE B.A./B.Sc./B.Com. (GEN.
/PROGRAMME) COURSE 1ST SEMESTER
SESSION :2021 – 2022
FOR OFFICE USE
Date of Admission : Course : Application Id : DNC21004423
Application Date : 10/08/2021 01:13 PM
Class Subject : Print Date : 10/08/2021 01:13 PM
Student’s Id
Roll No.:
......................................... .........................................
Signature Signature
(The filling of forms and uploading of the documents to be done with full responsibility of the
applicant and college authority in no way be held responsible)
PERSONAL PART
1. Name(in Block Letters) MRINMAY DAS 2. Date of Brith 18/02/2003
VILL-RAMAKANTAPUR, P.O- NURPUR, P.S- SUTI, DIST-MURSHIDABAD,
3. Address PIN-742223
3.1. P.s SUTI
4. Contact No. 7679715895 5. Nationality Indian
6. Religion Hinduism 7. Minority No
8. Gender Male 9. Caste / Category General
10. Sub Caste 11. Physically Challenged No
12. Father's Name SAMIR DAS 13. Father's Qualification Bellow Madhyamik
14. Mother's Name BARNALI DAS 15. Mother's Qualification No Literacy
16. Guardian's Name SAMIR DAS 17. Guardian's Contact No. 8670352049
18. Relation with Guardian FATHER 19. Sports Category
20. Aadhar No. 780126352767 21. Email ID yuvrajdas841@gmail.com
22. Whatsapp No 7679715895
ACADEMIC PART
23. H.S./ Roll No./Index No. 444211 1026 24. Year of Passing 2021
25. Name Council/Board West Bengal Council of Higher secondary Education Calcutta.
26. Name of the School GOTHA A R HIGH SCHOOL
27. Do You Have Computer Literacy : No
28. Statement of marks obtained in the H.S./Equivalent Examination
Political
Subject English Bengali History Education Philosophy
Science
Full Marks 100 100 100 100 100 100
Marks Obtained 65 65 63 65 65 65
APPLICATION PART
29. Subjects Applied for :
Srl. Programme in (CC 1) CC Subject 2 (Sem I to Language Core Compulsory Subject
Stream Course Type Merit Marks
No. (Sem I to IV) IV) Course (AECC)/MIL
1 B.A General Education Bengali Bengali 325
Declaration by the Candidate : 1. I do hereby declare that the above particulars are true to the best of my knowledge and belief and no relevant information are suppressed or omitted. I do hereby declare
also that I shall not be allowed to fill up the form for University Examination unless I secure at least 75% class attendance as per Regulations of the Kalyani University,nadia. I promise to abide by the rules and regulations
of the College. I agree to the condition that the particulars of forms filled and documents uploaded found to be incorrect/forged/mutilated, at any time, my admission will liable to be cancelled.
2. I agree to the condition that the particulars of forms filled and documents uploaded found to be incorrect/ forged/ mutilated, at any time, my admission will liable to be cancelled.
Date :
............................................................
Signature of Candidate
Declaration by the Father/Guardian :I do hereby certify that the applicant has taken my permission to seek admission in DUKHULAL NIBARAN CHANDRA COLLEGE and also the statements made
therein are to the best of my knowledge based on fact.
Date :
..............................................................
Signature of Father/Guardian
FOR OFFICE USE Admit Verified
Principal/ Teacher-in-Charge Signature
