1.   Name of the Applicant in Block Letters *-   

(Miss or Mrs. in case of Women)

2.   Name of the Father/Husband of the Applicant *-        Mother Name *-

a) Occupation* -   

b)Total Annual Income* -   

3.  Name of the Guardian, if the father is
is not alive/Name of local Guardian
and Address with Police Station & Phone No. -     

4. a) Permanent Home address with         Rly. Stn./Police Stn.*

b) Country*-  India

c) State*-  Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Puducherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal NA

d) Pin*-  Required Invalid Pin

e) Nationality*-  INDIAN FOREIGN STUDENT

f) Religion *- 

g) Gender*-       Male Female TransGender

h) Category-       GEN SC ST OBC-A OBC-B

i) Sub Category-       None EWS MM OM

j) Physically Challanged (Type of Disability)-       No Yes

k) Whether you received any Scholarship ? if yes then enter Scholarship Name , Category and Amount- 

l) Blood Group-       None A+ A- B+ B- AB+ AB- O+ O-

5.  Residence in Kolkata or Present Address*(P.O. , P.S , Municipality/Block , Pin) -     

5.  Gurdian Official Address* -     

a) Mobile No* -  c) Guardian Contact No*-   

d) Gurdian Email ID-    e) Email ID-*   
f) Locality-*    Urban Semi-Urban Rural    g)  AADHAR NO -  

6.  a)  Date of Birth(DD/MM/YYYY)- Required Invalid DOB       b)  BPL/APL- BPL APL

7. Whether the applicant has joined any other course of    study of this University or any other University/Institute -

8. Is Previously University Registered   Yes No

  Calcutta University Regn. Number-         & Year-   

9. a)  Whether Participated in any extra academic activities and   sports.If so, details thereof (Attested copy of Certificates to be)

9.a)  Extracurricular activity - -NA- NSS DRAMA PHOTOGRAPHY MOUNTAINEERING NATURE CLUB CULTURAL CLUB NCC KARATE MUSIC DANCE   b) Outstanding Sports Person - -NA- Archery Athletics Badminton Ball Badminton Basket Ball Best Physique Boxing Chess Cricket Diving Football Gymnastic Handball Hockey Judo Kabadi Kho Kho Lawn Tennis Netball Power Lifting Rowing Rugby Shooting Swimming Table Tennis Volly Ball Water Polo Weight Lifting Wrestling

10. Pass a) 1st Language English* - --Select-- YES NO Required

11. a) Whether employed. If so state name & address
of the employer,(if employed later on the
information must be given immediately) -     

 b) Whether higher examination from non formal education system
(Approved by Distance Council of India or UGC) : Yes No