Downloaded Form Office Use Only

Hons/Major Subject SL NO: CGF/ /2010

ASUTOSH COLLEGE D
92 S.P. MUKHERJEE ROAD, KOLKATA-700026
Phone : (91) (033) 2455 4504, 24542371/72
e-mail : mail@asutoshcollege.in Website : www.asutoshcollege.in

Application Form for Admission to First year B.A. / B. Sc. Hons/Major/General Course, 2010
1. Name of the Candidate in CAPITAL Letters: ____________________________________________________
2. Full Address in CAPITAL Letters: ____________________________________________________________
____________________________________________________________________ PIN Code:____________
Phone No: _______________________ 3. Date of Birth : Day: Month: Year:
4. Sex (Put [√] mark in Correct box): Male Female 5. Nationality: ________________________
6. Category for the purpose of reservation (Put [√] mark in Correct box):
General Scheduled Caste Scheduled Tribe Minority Category Physically Challenged
(Scheduled Caste, Scheduled Tribe, Minority or Physically Challenged candidate must enclose attested copy of caste, tribe,
minority or disability certificate from the competent authority with this application; otherwise the application may be rejected)
7. Name of the Board or Council of H.S. or equivalent Exam (Put [√] mark in Correct box):
WBCHSE ISC CBSE OTHERS
8. Stream of the studies in H.S. or equivalent Course (Put [√] mark in Correct box):
Science Arts Commerce Vocational
9. Roll Number of H.S. or equivalent Exam: 10.Year of Passing: 2 0
11. Marks obtained in the H.S. or equivalent Exam:
Subjects

Full Marks
Marks Obtained
(Enclose a clear Photocopy of mark sheet.)

12. Father's/ Mother's Name in CAPITAL Letters: ___________________________________________________

13. Course Applied for : (Use separate form for each course. Choose course name and general subjects combination from tables 1A
and 1B from our website. If you apply for a course for which you are not eligible, your application will be rejected.)
Hons./Major Subject General Subjects Compulsory Subjects
ENVS ENGC BNGM or HINM or
ENGM

DD or CBS
14. DD NO: Bank Name: ______________________________ Date:

(Not applicable for CBS) Amount: Rs.

Branch Name:
Declaration by Candidate
I, ____________________________________(Name of the candidate), hereby, declare that the information furnished above
by me are true to the best of my knowledge and belief. I agree that admission based on incomplete or incorrect information
shall be canceled.
Date: _____/_____/2010 Place: _________________________ ___________________________
Full Signature of the Candidate
…........................................................................................................................................................................................................................
Downloaded Form (To be filled in by the candidate) Office Use Only
SL NO: CGF/ /2010
Hons/Major Subject ASUTOSH COLLEGE
92 S.P. MUKHERJEE ROAD, KOLKATA-700026 D
Phone : (91) (033) 2455 4504, 24542371/72
Website : www.asutoshcollege.in
Received an application for admission to First year B.A. / B. Sc. Course, 2010 from E-mail : mail@asutoshcollege.in
Name in CAPITAL Letters : ______________________________________________________________________________
Roll Number in H.S. or equivalent Exams : Year of Passing 2 0
Hons/Major/General in ________________________________________________________________________________
DD NO: Bank Name: _____________________________ Branch Name:

Amount: Rs
Signature of the receiving official with the date and seal
Date: