KARIMGANJ COLLEGE, SRIBHUMI
(ESTD.-1946)
B-Grade (Re-accredited by NAAC)
APPLICATION FORM
for Admission to
Previous Class Roll No.: FYUG 2nd Year Semester III
FOR OFFICE USE ONLY
2566021953 Arts
Roll No.:
Session : 2026-27 Date of Admission:
Application Serial No.: 512603572
SAMARTH NO. / ARN : 250318257 ABC ID :
1. Name of Applicant : TASNIA AFROZ TAPADAR
2a. Mobile No : 7635849590
2b. Alternate Mobile No :
3. AADHAR Number : 946714080665
4a. Email ID : tapadartasnia8@[Link]
4b. Alternate Email ID :
5a. Date of Birth : 07/12/2005 5b. Age as on 1st July : 19 YEARS 6 MONTH 25 DAYS
6. Gender : Female
7. Religion : Islam 9. Community : MINORITY
8. Caste / Category : GEN
9. Do You Want to Avail FEE WAIVER SCHEME of Assam Govt.: YES
10. Are you citizen of India : Yes
11. Nationality : INDIAN
12. Domicile : Assam
13. ID Proof : Other Valid Govt. ID
14. ID Proof No : 946714080665
15. Other Category / Quota : a. Extra Curricular Activity : Not Applicable
b. Person with Benchmark (PWBD) Category : : Not Applicable
c. Are you from Tea Garden Community? : No
d. Are you Kashmiri Migrant? : Not Applicable
e. Prime Minister Special Scholarship for J&K Students : Not Applicable
f. Are you Ex-Serviceman ? : No
g. Are you descendent of freedom fighter? : No
h. Are you Single Girl Child ? : No
16. Address Details :
PERMANENT ADDRESS PRESENT ADDRESS
Address Line 1 BHATGRAM BHATGRAM
Address Line 2 BHATGRAM BHATGRAM
Post Office SHILCHAR ROAD SHILCHAR ROAD
Police Station SRIBHUMI SRIBHUMI
District Sribhumi Sribhumi
State Assam Assam
PIN 788713 788713
Cluster Name Bhatgram Bhatgram
Block Name South Karimganj South Karimganj
LAC Name Karimganj North
17. Family Information :
a. Mother's Name : FORHANABEGUMTAPADAR
b. Father's Name : ABDULHASIBTAPADAR
c. Local Guardian's Name :
SAMARTH NO. / ARN : 250318257 ABC ID :
Qualification Occupation Office Address Phone No.
Father Graduate Self Employed 6003018315
Mother Non Graduate Home Maker 7635849590
d. Combined Family Income : 60000 e. Emergency Contact No :
18. University Registration Details :
a. Have you enrolled in University / Autonomous Colleges before: No
b. If Yes Enrollment No: 20250001590
c. Name of University / Autonomous College:
d. Program registered with the University / Autonomous College:
e. In Case of any break of studies, the period and reasons thereof are to be stated: Period:
Reason:
f. Registration No. (If any): 2025 of: 20250001590
g. In Case of Transfer : Certificate No. Date :
Cause of Transfer
Permission Letter No. Date :
19. Academic Details
Name of Division/
Examination Name of Year of Roll Full Marks
Board/Council/ Subjects Grade
Institution Passing No. Marks Obtained
University Point/ %
Semester I AU KARIMGANJ BNGDSC101,BNGDSC102,PLSDS 2025 012525 650 194.0 29.85
COLLEGE M101,HSTIDC101,BNGSEC101,BN
GAEC101,NCCVAC101 100220498
Semester II AU KARIMGANJ PHPDSM151,HSTIDC151,ENGAEC 2026 022625 0
COLLEGE 151,EVSVAC151
100220498
Marks Details of Last Examination :
BNGDSC101 100.00 25.00
BNGDSC102 100.00 32.00
PLSDSM101 100.00 23.00
HSTIDC101 100.00 19.00
Bngsec101 100.00 54.00
Bngaec101 50.00 6.00
Nccvac101 100.00 47.00
20. Subjects Preferred :
Pref DSC 201 DSM 201 DSM 252 IDC 201 SEC 201 AEC 201
1 Bengali Political Science Philosophy History Bengali MIL Benagali
21. Other Details : a. Do you have any illness which require continuous or emeregency medical attention: No
b. Do you belong to Moran Community of Assam: No
c. Do you belong to fringe village of Assam: No
d. Area of Residence Rural
e. Are you Son / Daughter of Present Employee of college No
f. Are you Son / Daughter of Ex - Employee of college No
g. Do you have migration certificate No
h. Do you have transfer certificate from school / college No
i. Candidate havinf NCC 'B' 'C' certificate No
j. Have You attended any special camp under NSS No
SAMARTH NO. / ARN : 250318257 ABC ID :
22. Bank Details : Bank Name : PUNJAB NATIONAL BANK SARISHA
Account Number : 1097010193221 IFSC Code : PUNB0109720
23. Blood Group :
24. Whether willing to stay in the Hostel: NO
25. Have you applied in some other colleges?: NO Kg
26. Mother Tongue : BENGALI Height: 158 Cm Weight: 48
27. DECLARATION BY THE APPLICANT :
I do hereby declare that
i. the above particulars submitted by me are correct to the best of my knowledge and belief
ii. I shall abide by the rules and regulations of the college failing which the college authority may take any step which it deems fit and proper.
iii. I shall do nothing in or outside the college that may impair the discipline, good name and honour of the college.
iv. I shall attend the classes regularly and secure attendance of not less than 75% in each subject as stipulated by Assam Higher Secondary Education
Council / Assam University. I am fully aware that attendance of less than 75% in any of the subjects will debar me from appearing in the Council /
University Examinations.
v. I shall appear in all internal assessments and tests conducted by the college and secure the minimum prescribed marks in each subject.
vi. I will conform to the uniform and dress code in its entirety prescribed by the college.
vii. I will not use Mobile Phone inside the college campus.
viii. I will neither indulge in nor provoke any ragging inside or outside the campus. I am fully aware that involving in ragging is an offence and
punishable as per law.
If any of the above statements or information is found to be incorrect or if my conduct/ attendance/ result is not satisfactory, my
admission is liable to be cancelled and I shall have no claim to continue as student of this college.
(Signature in full of Father/Mother/Guardian) (Signature in full of the Candidate)
13/07/26
Date: ..................................
13/07/26
Date: ..................................
FOR OFFICE USE ONLY
DSC 201 DSM 201 DSM 252 IDC 201 SEC 201 AEC 201
Subjects
Recommended
Admission Fee : Rs.
Convenor, Admission Committe
Dealing Assistant (ADMISSION)
Cashier's Report Principal's Report
Received ₹ ...................................................... Admit Provisionally
Receipt No. ....................Date .........................
Principal
Signature of Cashier ........................................
LIST OF ENCLOSURES
Attested Photocopies of :
1. Admit Card of HSLC or equivalent examination.
2. Marksheet of Last Passed Examination.
3. Pass / Character Certificate from the Head of the Institution last attended for admission into HS-1 / TDC-1
4. Admit Card and Marksheets of last TDC examinations (For TDC 3rd & 5th Sem.)
5. Caste Certificate (if any)
6. Sports / NCC / Scout Certificate (if any)
7. Valid Income Certificate and photograph of tree planted if you want to avail Fee Waiver Scheme of Assam Govt.
SAMARTH NO. / ARN : 250318257 ABC ID :
Submission of online forms with subject combination does not guarantee admission. Admission will be finalised
by Admission Committee alongwith subject combination on the date of merit list publication (for 1st Sem only)
UNDERTAKING FOR ATTENDENCE
I TASNIA AFROZ TAPADAR do, hereby, give the
undertaking that I shall attend 75% of the classes failing which I will not
be allowed to fill up the forms of TDC/HS Final Examination conducted
Assam University, Silchar or Assam Higher Secondary Council, as the
case may be.
(Signature in full of Father/Mother/Guardian) (Signature in full of the Candidate)
Date: 13/07/26 Date: 13/07/26
CAUTION REGARDING RAGGING ACTIVITY
Any kind of involvement in ragging activity or giving indulgence to
such activity is a punishable offence as per the "UGC Regulations
on curving the menace of ragging in higher education institutions,
2009" notified on 4th July 2009 in the Gazette of India in persuance
to the judgement of the Hon'ble Supreme Court of India dated
08.05.2009 consequent upon Civil Appeal No. 887/2009.
Admission Fee : Rs.
Application Serial No.: 512603572
Name of Applicant.: TASNIA AFROZ TAPADAR
Class and Sem: FYUG 2nd Year Semester III
Stream: Arts