FORMAT OF APPLICATION FORM

MAMATA ENTRANCE EXAMINATION – 2023

1. Name :_________________________________________ Photo

2 Present . Address : ________________________________________

________________________________________

_______________________Pin Code_____________

3. Permanent Address :_______________________________________________________

_______________________________________________________
______________________________Pin Code _________________

4. Phone No :Code No._____________ Phone No. _________________________________

Mobile No. (1)____________________(2)____________________(3)___________________
E-mail ID:-__________________________________________________________________

5. Birth Date : __________________As on 1/8/2024 Age: year_____Month______Day_____

6. Category : General / S.C. / S.T. / SEBC

7. Mother Tongue : _____________________ .

8. Educational Qualification:

Sr. Name of Name of University Details of Marks

No Degree Total Marks Obtained Marks Percentage
1

I certify that above details are correct and if found incorrect, I am bound to accept the
decision of cancellation of my admission.

Date :- / /2023. Signature : -

Place : -