APPLY ADMISSION FORM-2015 BATCH

ESTD. 1984

HELPLINE:-06243-261104 (O)
9709090030 (R)

PANCHADEVI SHYAMAKANT INTER COLLEGE

SADANANDPUR (BALIYA) BEGUSARAI
( Affiliated to Bihar School Examination Board , Patna)
SESSION : 2015-2017
FACULTYREGISTRATION NO.-..................................................(OFFICE USE ONLY)
TO,
THE PRINCIPAL,
P.D.S.K. INTER COLLEGE
Sadanandpur, Begusarai
COMPULSORY SUBJECT

OPTIONAL SUBJECT

1.

1.

2.

2.

3.

3.

ADDITIONAL SUBJECT
1.

* All the important information for the office is being given below:-

STUDENT NAMEMOTHER'S NAMEFATHER'S NAMEMAILING / PERMANENT ADDRESS:VILLAGE-

POST-

P.S.-

DISTRICT-

PIN CODE-

STATE-

CONTACT / MOBILE NO.D.O.B.CASTE-

SEX-

STATUS-

RELIGION-

NATIONALITY-

QUALIFICATION
EXAMINATION NAME

PASSING YEAR

BOARD NAME

MARKS OBTAIN

10-th Examination
only for CGPA

APPLY
DATE-

SCHOOL / COLLEGE REG. NO.

TOTAL MARKS

only for CGPA

2015

NOTE- *The Student's shortlisted and Selected will be on the basis of marks obtain in class 10-th Board exam.
* This is not Admission form i.e.- This is only Admission Apply form. after this student's will be shortlisted for Admission on Limited Sheets.

Declaration- All the Information is given by me is TRUE (

) and if any stage the information given by me will be
FALSE ( x ) then I'am responsible for Cancel the Admission and related Fee. i.e- Fee not be Refunded.

I AGREE ALL THE T&C* OF INSTITUTE.- SIGNATURE (Student / Parent's)............................................................

OFFICE USE ONLY

Receiving Slip for Student.
REGISTRATION NO- ............................................

DEALING STAFF SIGNATURE...................................................