APPLICATION FORM FOR ADMISSION IN PG PROGRAMME

Full name of the Applicant

Mobile No.*

Phone

Gmail ID*

Gmail ID

Father’s Name*

Father’s Name

Mother’s Name*

Mother’s Name

Father’s/ Mother’s Occupation:*

Father’s/ Mother’s Occupation:

Local Guardian’s Name if any:

Relationship :

Course in which admission is sought:*

Department:*

Name of the last Examination passed with year*

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Registration No*

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Name of the College(Autonomous)/University*

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Class*

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Roll No*

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Percentage*

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Category*

Age*

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Date of Birth*

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Permanent Address*

Vill/town

P.O

P.S

Dist

State

Guardian Ph. No*

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Is Your Address for Correspondence same as Permanent address?*

Address for Correspondence*

Vill/town

P.O

P.S

Dist

State

Guardian Ph. No*

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Sex*

Whether you were debarred earlier by an educational institutions?*

Any Police Case registered or pending against you?*

Proficiency in other activities*

Level of Participation*

Bank Account details

Name of bank*

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Name of branch*

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A/C No.*

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IFSC No*

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Payment Details

A/C No. 40889862442

IFSC No. SBIN0002051

G-Pay No. 9365731911

Name of the Account Holder: Biswajyoti Googoi