2/8/24, 2:54 PM Student Admission, S.B.S.S.

College Begusarai

S.B.S.S. College Begusarai

A Constituent Unit of Lalit Narayan Mithila University, Darbhanga(Bihar) India

Graduation Part-III Admisssion Form

Unique Form Id College Roll No. University Roll No. Faculty Honours Course Session
212662381 4598 221024020230 Science Chemistry 2021-24

Personal Information
Student Name ANKIT KUMAR

Father's Name JAY PRAKASH SINGH

Mother's Name RATNA DEVI

Date of Birth 23-10-1999 Merital Status UNMARRIED

Gender Male Category GEN

Religion HINDU Nationality INDIAN

Mobile Number 9430198772 Email Id ankitgolu9430@gmail.com

Aadhaar Number 726586661497

Admission Course Details

Faculty Science Honours Chemistry

Course Session 2021-24 College Roll No. 4598

University Roll No. 221024020230 University Registration No. 21102008620

Part-I & Part-II Marks Details

Honours Subsidiary 1 Subsidiary 2 Language 1 Language 2
Exam
( Chemistry ) ( Mathematics ) ( Physics ) ( MB Non Hindi-50 ) ( English-50 )

Part-I 135 52 75 33 37

Part-II

Address Details
Village/AT Post Office Police Station District State Pin Code

GIDDI A GIDDI A GIDDI A HAZARIBAGH JHARKHAND 829108

Bank Details
Bank Account Number 4901001700014311 Account Holder Name ANKIT KUMAR

IFSC Code PUNB0490100 Bank Name PUNJAB NATIONAL BANK

Payments Details
Payment Id Payment Date Total Amount
18005397773 25-08-2023 ₹ 1,340.00 (One Thousand Three Hundred and Forty Rupees Only)

Declaration:-
मैं घोषणा करता/करती हूँ कि इस आवेदन में दी गई सभी सूचनायें सही है। गलत सूचना के आधार पर नामांकन होने पर मेरा/मेरी नामांकन रद्द समझा
जाये। नामांकन के समय मेरे द्धारा जमा कि गयी राशि वापस लेने का/की मैं हकदार नहीं रहूँगा/रहूंगी। वर्ग में उपस्थिति 75% से कम होने पर परीक्षा
प्रपत्र जमा करने से मैं स्वतः वंचित हो जाऊँ गा/ जाऊँ गी।

Date : 25-08-2023

Note:- सभी छात्र/छात्राओं को सूचित किया जाता है कि इस नामांकन फॉर्म (Admisssion Form) को कॉलेज में जमा कर दें तथा एक प्रति अपने पास
सुरक्षित रखें ।

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2/8/24, 2:54 PM Student Admission, S.B.S.S. College Begusarai

S.B.S.S. College Begusarai

A Constituent Unit of Lalit Narayan Mithila University, Darbhanga(Bihar) India

Graduation Part-III Admisssion Money Receipt ( COLLEGE COPY )

Payment Id 18005397773

Date 25-08-2023

College Roll Number 4598

Unique Form Id 212662381

University Roll No. 221024020230

University Registration No. 21102008620

Faculty Science

Honours Chemistry

Course Session 2021-24

Student Name ANKIT KUMAR

Father's Name JAY PRAKASH SINGH

Mother's Name RATNA DEVI

Gender Male

Category GEN

Admisssion Fees 1,340.00 (One Thousand Three Hundred and Forty Rupees Only)

Payment Mode Online

Signature of Student Signature of College Authority

https://www.onlinesbsscollege.com/ugpart3/student_form_print 2/3
2/8/24, 2:54 PM Student Admission, S.B.S.S. College Begusarai

S.B.S.S. College Begusarai

A Constituent Unit of Lalit Narayan Mithila University, Darbhanga(Bihar) India

Graduation Part-III Admisssion Money Receipt ( STUDENT COPY )

Payment Id 18005397773

Date 25-08-2023

College Roll Number 4598

Unique Form Id 212662381

University Roll No. 221024020230

University Registration No. 21102008620

Faculty Science

Honours Chemistry

Course Session 2021-24

Student Name ANKIT KUMAR

Father's Name JAY PRAKASH SINGH

Mother's Name RATNA DEVI

Gender Male

Category GEN

Admisssion Fees 1,340.00 (One Thousand Three Hundred and Forty Rupees Only)

Payment Mode Online

Signature of Student Signature of College Authority

Note:- इस नामांकन रसीद को छात्र/छात्रा अपने पास सुरक्षित रखें , कॉलेज द्वारा मांगे जाने पर कॉलेज में प्रस्तुत करना अनिवार्य
होगा।

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