6/30/2017 Derozio Memorial College ||

DEROZIO MEMORIAL COLLEGE

Rajarhat Road, PO- R. Gopalpur, Kolkata - 700 136, Phone: (033)-2519-6050
APPLICATION FORM
For 1st Year B.Sc. Mathematics (Honours) Course

Form/Profile No. : 11317002146 Session : 2017-2018

Migrated * YES NO Year : 1st

Student Code * (Hons./Gen) *
Transferred From *
Date of Admission * College Roll No. *
Subjects Applied for/ Taken Compulsory Subjects :
Courses B.Sc. Mathematics (Honours) Course
Subjects(Hons/General, General, General) : Mathematics, Physics, Computer Science
Name : NASRIN KHATUN
Date of Birth : 22-05-1999 Caste : GEN Sex : FEMALE
Nationality : INDIAN Religion : Islam Minority : YES Blood Group :
Ch. Category (PH) : NO % of disability : 0 Economically Ch. Category :
Fathers Name : JABBARALI MOLLA
Fathers Occupation : BUSINESS Education : 10 Fathers Yearly Income : 50000
Mothers Name RAHEMA BIBI
Mothers Occupation : HOUSE WIFE Education : 10 Mothers Income : NIL
Legal Guardian : JABBARALI MOLLA Relationship : DAUGHTER
Local Guardian : JABBARALI MOLLA
Present Address :
Permanent Address : PANAPUKUR, PANAPUKUR, DISTRICT : NORTH 24 PARGANAS, PIN : 743502
Phone No (L/M): 8768542789, 8768542789 Nearest Rly Station :
Permanent Address : PANAPUKUR
Email ID :
Last Board/Council : W.B.C.H.S.E. Year of Passing : 2017
Board Reg. No. : 2017 Reg. Year : 2017 Roll No. : 4622211087
Details of Kannyashree (If applicable)
Aadhar No. : Working? : NO
:
Th.
F.M. F.M. Project/ F.M. F. M.
Subjects Marks P/Pr Marks Obtained Status (P/F)
Theory Practical Total Obtained
Obtained
Bengali 80 62 20 20 100 82 PASS
English 80 57 20 20 100 77 PASS
Biological Sciences 70 34 30 30 100 64 PASS
Chemistry 70 24 30 28 100 52 PASS
Physics 70 21 30 29 100 50 PASS
Mathematics 80 50 20 20 100 70 PASS
Mother
Total of best 4 Subjects (Based on your input) : 293 Merit point : Tongue :
BENGALI
I have gone through the college rules & regulations and agree to follow strictly the disciplinary rules of the college and university. I promise to abide
by the rules and regulations of our university and college.
Admitted :

Principal/Teacher-in-Charge/
Admission Authority Signature of Father/Guardian Signature of Student

[ * For office use only ]

file:///C:/Users/mdsarifuddin/Desktop/Derozio%20Memorial%20College%20_nasrin.htm 1/1