BIRLA INSTITUTE OF TECHNOLOGY GOVT, OF WEST BENGAL, 86 B.T, ROAD, KOLKATA-700050, ae “4 COLOUR SINo:- SSION Ft EXP PASSPORT BRANCH ..... APPLICATION NO... STUDENT'S NAME GENDER ........ DATE OF BIRTH ans TRSCTRTTST CAST... » NATIONALITY «0. FATHER’S NAME... a MOTHER'S NAME ...... aceite eee GUARIDAN NAME... ADDRESS... BOARD OF MADHYAMICK 1.0... FROM SCHOOL... PERCENTAGE OF MARKS (WITHOUT ADDITIONAL SUBJECT) ... . REGISTRATION NO ... YEAR OF REGISTRATION .... ADDMISSION QUOTA (TICK) (GENERAL /SC /ST /OBC-A /OBC-B /PC /TFW /LAND LOOSER /MINORITY ) GUARIDAN SIGNATURE STUDENT SIGNATURE (OFFICE USE ONLY) MONEY RECEIPY NO.. DATE OF JOINING . VERIFIED BY .. DEPARTMENT... ROLLNO sesssnteBIRLA INSTITUTE OF TECHNOLOGY GOVT. OF WEST BENGAL 56 B.T. ROAD, KOLKATA-700050. FORMAT FOR IDENTITY CARD ID NO sssecseene SESSEION 2021-22 STUDENT S:NAME .«.sessassssceesasanesnnseuvesssiavssneacasreasonssesvanansarearsnrsanniossevoneee ADDRESS ......csceseseereeteessetnenseseessesnees Asereeeeseecesees {dusseeeseenssssessensessssensencese DATE OF BIRTH ..........s0essssssesssscsstsersoees BLOOD GROUP CONTACT NO BRANCH .... PHOTO. COLOUR PASSPORT SIGNATURE IN FULLFOR FINAL ADMISSION OF JEXPO & VOCLET 20: AST SET 1, FINAL ALLOTMENT LETTER (ORIGINAL) RANK CARD (ORIGINAL) MARKSHEET OF MADHYAMIIK ( ORIGINAL + PHOTOCOPY) ‘ADMIT CARD OF MADHYAMIK (ORIGINAL + PHOTOCOPY) DOMICILES CERTIFICATE (A&B FORMAT ORIGINAL) FOR OTHER STATE ( C FORMAT ORIGINAL ) MEDICAL FITNESS CERTIFICATE SPECIFIED FORMAT BY COUNCIL (ORIGINAL) ANTI RAGGING AFFIDAVIT BY NOTERY (ORIGINAL) ‘CAST CERTIFICATE (IF ELIGIBLE) ( ORIGINAL + PHOTOCOPY) ‘TFW CERTIFICATE WITH PROPER FORMAT (IF ELLIGIBLE) (ORIGINAL) 10. LLQ CERTIFICATE (IF ELIGIBLE) WITH PROPER FORMAT (ORIGINAL +PHOTOCOPY) penoaw awn 11, PC CERTIFICATE (IF ELIGIBLE) WITH PROPER FORMAT (ORIGINAL +PHOTOCOPY) 12. KANYASHREE CERTIFICATE (IF ELIGIBLE) (PHOTOCOPY) 13. AADHAR CARD (ORIGINAL + PHOTOCOPY) 2ND SET 1. FINAL ALLOTMENT LETTER (ORIGINAL) RANK CARD (ORIGINAL) MARKSHEET OF MADHYAMIK (PHOTOCOPY) ADMIT CARD OF MADHYAMIK (PHOTOCOPY) CAST CERTIFICATE (IF ELIGIBLE) ( ORIGINAL + PHOTOCOPY) LQ CERTIFICATE (IF ELLIGIBLE) WITH PROPER FORMAT (ORIGINAL +PHOTOCOPY), PC CERTIFICATE (IF ELIGIBLE) WITH PROPER FORMAT (ORIGINAL +PHOTOCOPY) KANYASHREE CERTIFICATE (IF ELLIGIBLE) (PHOTOCOPY) AADHAR CARD (ORIGINAL + PHOTOCOPY) pena awn 3RD SET FINAL ALLOTMENT LETTER (ORIGINAL) RANK CARD (ORIGINAL) MARKSHEET OF MADHYAMIK (PHOTOCOPY) ADMIT CARD OF MADHYAMIK (PHOTOCOPY) CAST CERTIFICATE (IF ELLIGIBLE) ( ORIGINAL + PHOTOCOPY) LQ CERTIFICATE (IF ELLIGIBLE) WITH PROPER FORMAT (ORIGINAL +PHOTOCOPY) PC CERTIFICATE (IF ELLIGIBLE) WITH PROPER FORMAT (ORIGINAL +PHOTOCOPY) KANYASHREE CERTIFICATE (IF ELLIGIBLE) (PHOTOCOPY) ‘AADHAR CARD (ORIGINAL + PHOTOCOPY) pene w awn eo