Form_No:

D 1 3 5 0 4 0 0 Paste Passport
College Code Continuous Serial No University of Calcutta Size
87/1 College Street, Kolkata-700073 Photography
Website: www.caluniv.ac.in
Email: calunivregn@gmail.com

Phone No: 22410071 / 22410072/ 22410073/ 22410074/ 22410076 Ext-207

Course
(For any assistance contact us at given phone numbers or mail us)

Course Code( Refer To Table A2) 0 9 Student's Signature in the box

Registration Form
Strike out which
Non-Migrating Migrating 284951086914
is not applicable

✓ AAdhar No.(if Available)

(Admission should be made strictly as per latest CSR Notifications)

1. Roll Number of (10+2) level Examination: 461812 1004 2. Year of Passing (10+2) Examination: 2016
3. Name of College/ Department/ Institution: Vidyasagar College
4. Date of Admission to the School/ College/
2 2 / 0 6 / 2 0 1 8
Department:
5. Session of Admission: 2018-2019
6. Whether passed (10+2) or Higher
examination from Non-Formal education system Yes No ✓
(Approved by Distance Council of India or UGC):
7. Name (IN CAPITAL LETTERS) 8. Father's Name 9. Mother's Name
SOURAV SAMADDAR NIKHIL SAMADDAR FUL RANI SAMADDAR
10. Present or Permanent Address: Ramkrishna Pally. P.O- Gouranga nagar. West Bengal. PIN- 700159
11. Pin Code: 7 0 0 1 5 9 12. State: West Bengal 13. Country: India
14. Mobile No.: 9830149079 15. Email Address: souravsamaddar97@gmail.com
16. Gender: Male ✓ Female TransGender 17. Religion: Hinduism 18. Category: General SC ✓ ST OBC OBC-A
19. Date of Birth: 2 6 / 0 9 / 1 9 9 7
20. Nationality: Indian 21. Physically Challenged: Yes[VH/HI/OH]: No ✓
22. Annual Family Income (In INR) 72000 23. Locality Type[Urban/Semi-Urban/Rural]: Urban
24. BPL/APL: No 25. Course of Study: B.Sc Honours
26. Subjects ( Honours / Major Stream): [use code only]
Hons./Major Generic Elective Generic Elective AECC1 AECC2
CEMA MTMG PHSG BNGM ENVS
26A. Subjects ( General Stream): [use code only]
General/Generic
General General LCC1 * LCC2 * AECC1 AECC2
Elective *

27. University/Board of last qualifying examination

W.B.C.H.S.E

AECC1: Communicative English / MIL (Bengali/Hindi/Urdu) Contd.......

LCC1: English Courses; LCC2-MIL: (Bengali/Hindi/Urdu)/Alternative English

* For B.A. General Only

28. Please tick (✓) in the appropriate box

Passed from W.B.C.H.S.E. /

(a) Non-Migrating Student
I.S.C/ C.B.S.E/ N.I.O.S/ Rabindra Mukta Vidyalaya
✓

(b) Migrating Student Passed from other Boards/University

29. Furnish the Details of subjects and marks obtained in the last Examination./ Details of previous
qualifying examination Boards/ University [Applicable for the Students under Slno 28 (a) and (b)]
Aggregate
Top Four Subjects(excluding the
of Top
compulsory paper on Environmental
Subject(s) four
Education)
subjects
Biology Chemistry English Mathematics - Physics Bengali -
Full Marks 100 100 100 100 100 100 100 -
Marks Obtained 94 91 80 80 345 75 74 0 -

I do hereby declare that the statements made above are true and correct and the documents furnished along with the form are genuine
to the best of my knowledge and belief. In case any of the documents is subsequently detected to be fake or false, my Registration
with the University shall be treated as cancelled.

Date:................................. .......................................................
Signature of the Applicant in full
I certify that all the statements made above are verified and found to be true.

Date:................................. .......................................................
Signature of the Principal/Vice-Principal/
Teacher In-Charge/Head of the Institution/
Secretary Faculty Council with Office Seal