Student Copy

SRI ARVIND MAHILA COLLEGE, PATNA

ADMISSION FORM - I.A XII
SESSION 2021-23
Personal Details
1 Student Name: SAKSHI KUMARI

2 Father's Name : LAV KUMAR

3 Mother's Name : KHUSHBOO DEVI

4 Gardian's Name : LAV SHARMA

Reference Number: Applicant's Id : Date of Birth :

21J1878968 202108514887 01/01/2004
Nationality : Gender: Family Annual Income:
INDIAN FEMALE UP TO 1 LAKH
Religion : Category: Caste:
HINDU GENERAL BHUMIHAR
Physically
Blood Group : Marital Status:
Challenged:
B+ NO UNMARRIED
Applicant Aadhaar No : Mobile No: Email Id:
916689013046 7004552599 ROUSHANRAJSINGH28101999@GMAIL.COM

5. Course Details

Course : IA Optional Subject 1 : HISTORY

Optional Subject 2 : POLITICAL SCIENCE Optional Subject 3 : SOCIOLOGY

Extra Subject : NONE Language 1 : HINDI(100 MARKS)

Language 2 : ENGLISH

Exam. Name : Exam. Board : Year : Result :

10TH. BSEB 2020 III CLASS.
6. Last Exam. Passed : MATRICULATION
Obt. Marks/Gr. : Full Marks/Gr. : Obt. % : Elective Sub.:
164 500 16400% NA

7.Address for Correspondence

a. Address D/O LAV SHARMA , NEURI b. District PATNA

c. Police Station NEURI d. State BIHAR e. PIN Code 801113

8. Office Endorsement for Admission

Admission Allowed Not Allowed
PRINCIPAL:
Sign of Assistant : Sign Admn. In-Charge : Sign Admn. In-Charge :
Undertaking by Applicant & His/Her Parents / Guardians :

01. We (myself & my parents / guardian) hereby declare that all above mentioned information are correct & true and that, if in case
any information and the documents uploaded by me with this application, at any stage found to be wrong or misleading, then legal
action may be taken against me with immediate cancellation of my admission.

02. Will not request to change subject after admission.

03. In case of irregularity in attending classes, college administration may cancel my admission.

04. I shall be debarred from filling examination form in case my attendance is not upto 75%.
 SRI ARVIND MAHILA COLLEGE, PATNA College Copy

ADMISSION FORM - I.A XII

SESSION 2021-23
Personal Details
1 Student Name: SAKSHI KUMARI

2 Father's Name : LAV KUMAR

3 Mother's Name : KHUSHBOO DEVI

4 Gardian's Name : LAV SHARMA

Reference Number: Applicant's Id : Date of Birth :

21J1878968 202108514887 01/01/2004
Nationality : Gender: Family Annual Income:
INDIAN FEMALE UP TO 1 LAKH
Religion : Category: Caste:
HINDU GENERAL BHUMIHAR
Physically
Blood Group : Marital Status:
Challenged:
B+ NO UNMARRIED
Applicant Aadhaar No : Mobile No: Email Id:
916689013046 7004552599 ROUSHANRAJSINGH28101999@GMAIL.COM

5. Course Details

Course : IA Optional Subject 1 : HISTORY

Optional Subject 2 : POLITICAL SCIENCE Optional Subject 3 : SOCIOLOGY

Extra Subject : NONE Language 1 : HINDI(100 MARKS)

Language 2 : ENGLISH

Exam. Name : Exam. Board : Year : Result :

10TH. BSEB 2020 III CLASS.
6. Last Exam. Passed : MATRICULATION
Obt. Marks/Gr. : Full Marks/Gr. : Obt. % : Elective Sub.:
164 500 16400% NA

7.Address for Correspondence

a. Address D/O LAV SHARMA , NEURI b. District PATNA

c. Police Station NEURI d. State BIHAR e. PIN Code 801113

8. Office Endorsement for Admission

Admission Allowed Not Allowed
PRINCIPAL:
Sign of Assistant : Sign Admn. In-Charge : Sign Admn. In-Charge :
Undertaking by Applicant & His/Her Parents / Guardians :

01. We (myself & my parents / guardian) hereby declare that all above mentioned information are correct & true and that, if in case
any information and the documents uploaded by me with this application, at any stage found to be wrong or misleading, then legal
action may be taken against me with immediate cancellation of my admission.

02. Will not request to change subject after admission.

03. In case of irregularity in attending classes, college administration may cancel my admission.

04. I shall be debarred from filling examination form in case my attendance is not upto 75%.