THE UNIVERSITY OF BURDWAN

Placement and Students Welfare

GOLAPBAG, BURDWAN-713 104
WEST BENGAL, INDIA
Phone : (091)-342-2656553 EPABX Extn. 416
Fax : (091)-342-2530452

50 YEARS OF ACADEMIC EXCELLENCE

GOLDEN JUBILEE CELEBRATION 2009-2010
GENERAL INSTRUCTIONS
1. Application Forms are to be purchased from the sales counter located at the Rajbati
campus of the University on payment of required fees mention in the forms. The Forms
may also be downloaded from this site by clicking on the respective links given below.
2. The Application Fees, as mentioned in the Forms are is to be paid either by cash (to be
deposited at the University cash counter, Rajbati) or by Demand Draft drawn in favour of
Finance Officer, The University of Burdwan payable at S.B.I., Burdwan University
Branch.
In case of downloaded Application Forms, the prices of the Application Forms are to be
paid along with the prescribed application fees.
3. The filled up Application Forms along with the documents mentioned in the respective
Forms and the money receipt (for cash deposit) or the Demand Draft are to be submitted
to the Registration & Migration section of the University.
4. Outstation candidates may send the filled up Application Forms along with the documents
mentioned in the respective Forms and the money receipt (for cash deposit) or the
Demand Draft and a self addressed stamped envelope by post to the address mentioned
below.
The Placement and Students Welfare Officer
The University of Burdwan
Golapbag Campus
Burdwan - 713104
West Bengal
India.
5. For any further clarification, candidates may contact the above person at 0342-2656553
Extn. 416
Submission of Forms and Collection of the Certificates could be done personally by the candidate
or his/her representative (on production of authorization certificate).

Serial No............

Price Rs. 10.00

THE UNIVERSITY OF BURDWAN

50 YEARS OF ACADEMIC EXCELLENCE
Photograph

APPLICATION FORM

FOR

ADMISSION

INTO

UNIVERSITY HOSTELS

A.

(i) Name of the Applicant..................................................................................(ii) Phone No............................

B.

(i) Subject and course of study...........................................................................(ii) For Admn...........................

C.

(i) Married/Unmarried......................................................... (ii) Religion................................................................

(iii) Whether belongs to S.C./S.T./O.B.C./P.H. (if Yes submit documents).......................... (iv) Sex..................
Name of Local Guardian......................................................................................................................................
Address.................................................................................................................. Phone No..............................
Name of authorised visitors and relationship (1)................................................................................................

D.
E.

(2)....................................................................................... (3)..........................................................................
DECLARATION

1.

Fathers/Guardians/Husbands Name

2.

Residential Address of the Applicant

(Photo copy of Voter identity Card/Ration

Card/Driving Licence duly attested by the
appropriate authority must be enclosed)

3.

Route direction

(By Bus or by Train in the shortest

route which is normally used to travel
from Burdwan Town)

4.

Nearest Rly. Station/Bus Stand

5.

Nearest place of prominence

(in the route direction)

6.

Distance from the nearest Rly. Station/ :

Bus Stand to the residential place

7.

Distance from Burdwan Town to the

nearest Rly. Station/Bus Stand
Distance from the place of prominence
to the residential place
Distance from Burdwan Town to the
place of prominence
Total distance from Burdwan Town to
the place of residence

8.
9.
10.

:
:
:
:

(Sl. No. 6+7 or 8+9 which is lesser)

I do hereby declare that all the statements made in this application are true to the best of my knowledge and belief and
in the event of any of the information found false or incorrect before and after my admission in the University Hostel, my allotment
in the hostel is liable to be cancelled and appropriate action be initiated against me.
I also agree to abide by the existing rules of the hostels.

VERIFIED

AND FOUND CORRECT

COUNTERSIGNED

Signature of the Applicant

Date...................................

Signature of appropriate authority with official seal

(Local Panchayet Pradhan/B.D.O./S.D.O./D.M./Zilla Sabhadhipati/
Commissioner/Councillor/Chairman, Municipality)
SBUP. 1876A/05-09/10,000 (C)

............................................................

Countersignature of the Guardian