VISVA-BHARATI

SANTINIKETAN

Sl.No. Gen./OBC/2014.............
For General / O.B.C. Candidates
Cash Coupon/Receipt/Demand Draft

No.................. Date of Issue....................

Issuing Bank............... Branch..................... Attested copy of
Passport size
For Office Use photograph to be
affixed here
Called for Admission Test : Yes  No 
Roll No. ___________ Score : ______

Application for admission to .................................................................(write the name of the Institute)

for the session 200 - 200

1. Admission sought to
(i) Pre-degree (+2)  (ii) Under-graduate 
(iii) Post-graduate  (iv) Certificate 
(v) Diploma  (vi) Other Course. 

2. Name of the Course .........................................................................................................................

(i) Core/Major Subject(s).........................................................................................................
(ii) Elective/Subsidiary Subject(s) ..............................................................................................
(iii) Vocational/General Subject(s) ..............................................................................................

3. Name in full (in block letters) : .......................................................................................................

4. Whether belonging to :
(i) Other Backward Classes  (iv) Ward of Visva-Bharati employee 
(ii) Physically Handicapped  (v) General/Unreserved category 
(iii) Internal Candidate 
5. Father’s Name : ..........................................................................................................................
6. Guardian’s Name : ..........................................................................................................................
and Annual Income ..........................................................................................................................

7. Address for communication : ..........................................................................................................

............................................................................................................................................
...........................................................Pin Code ..................... Telephone No. ...................

8. Permanent Address : ………............................................................................................................

............................................................................................................................................
............................................................................................................................................
..................................................................................................Pin Code ..........................

9. Sex : Male  Female 

10. (a) Nationality: ............................................................. (b) Religion:................................................

11. Date of Birth with Place : ...................................................................................................................

Contd. ...2
 -2-
12. Admission is sought as :
(a) Resident  (b) Day Scholar 
(c) Whether prepared to get admitted as a Day Scholar if no hostel seat is available Yes  No 

13. Particulars of candidate’s previous academic records :

Name of the Board/Council Name of School/ Year of Total % of Div./ Subjects taken
Examination /University College Passing Marks Marks Class
obtained

14. Are you an outstanding sports person? If yes, state the level of participation in Sports and Games:
(i) National  (ii) State  (iii) University  (iv) District 
Note: Attested copies of certificate of participation issued by the competent authority as specified in the
Information Brochure.
15. Are you already registered as a Visva-Bharati student? If so,
Registration No. ____________________ Year ___________ Bhavana _____________________
Course _________________________________

16. I hereby declare that the above statement made by me is correct to the best of my knowledge and belief and I
shall abide by the rules and regulations of the University and in the event of any information supplied by me is
found false, my admission to the aforesaid course is liable to be cancelled.

17. I further declare that I shall attend classes regularly to obtain the minimum required attendance of 75% during
the aforesaid course, failing which I shall abide by the action to be taken against me by the University
authorities.

____________________________ _______________________
Counter signature of Signature of the Candidate
Father/Mother/Guardian Date :...............................
Date : ............................

Note:
(a) While filling up the form, please put the tick ( ) in the appropriate box as the case may be.
(b) Application must be accompanied by :
(i) Age Certificate, (ii) Leaving Certificate from the School, College, Institute or the Board last attended, (iii)
Attested copies of marksheets of all previous public examinations, (iv) Certificate from a respectable person
who knows the candidate personally certifying his/her character, (v) Pass certificates of all previous public
examinations, (vi) Migration Certificate (where applicable), (vii) *Income Certificate.
The application will not be entertained if the above enclosures are not attached with it. However, if the pass
certificate of the previous examination and the Migration Certificate can not be produced at the time of
admission due to non-availability, the same must be produced within THREE MONTHS from the date of
admission, otherwise the admission will be treated as cancelled.
(c) In the case of an OBC candidate, the onus of proving that he/she does not belong to the ‘creamy layer’, shall
rest with the candidate. Accordingly, OBC candidates are advised to enclose appropriate certificates in this
regard as per relevant directives of the Government of India.

*The income certificate of the guardian must be certified by (i) a Gazetted officer or (ii) the
Employing Authority or (iii) the local authority (B.D.O./Panchayat Pradhan/Head of the Institution last
attended/Chairman, Municipality).

Price : Rs.500.00 only.