CALCUTTA GIRLS’ COLLEGE College Code: 3, GOALTULI LANE , KOLKATA -700013 Lid ¢ ‘Application No: 4YR -B.A/204 § / ForCollege use | course Applied For 4YR-B.A. (HONOURS WITH OR WITHOUT RESEARCH) | Registration Ne, | only a 2674091 abi Mediums NA Registration Date: 02/07/2023 1. Personal information section Last Name First Name Middle Name Name of Student MAHFOOZ AIMAN Father's Name MAHFOOZ ALAM, Mother's Name: TABASSUM SHAHIN In-House Student: 0 Marital Status: UNMARRIED Saral No Date of Birth: 07/08/2005 Gender: FEMALE Place of Birth: HOWRAH Blood Group: PLEASE SELECT Grandfather's Name: Native Pla Voter ID card No.: (Organ Donor: NO Bank Name: ‘Account No Transaction Type: OFFLINE Religion: (SLAM Nationality: INDIAN UDISE No. ‘Aadhaar card No.: 213629443505 Driving Licence No.: Eligibility No. 2. Address Details ‘Address of Correspondence: 15, PM BASTI 1ST BYE LANE SHIBPUR HOWRAH - 711102, Pin Code: 711102 State: WEST BENGAL District: HOWRAH Tehsil: City: HOWRAH Permanent Address: 15, PM BASTI 1ST BYE LANE SHIBPUR HOWRAH - 711102, Pin Code: 711102 ‘State: WEST BENGAL District: HOWRAH Tehsil: ity: HOWRAH 3. Contact Details, ‘Student Mobile No.: 9903327745 Alternate Contact Num! ‘Student Emai TABASSUMSHAHIN46@GMAILCOM Parent phone: 9903327745 4, Legal Reservation Information Section Domicile state: ‘Admission Category: GENERAL Caste Category: GENERAL Cast Phy. Handicapped: Caste Certificate No.: Learning Disability No.:5. Social Reservation (Special Category) Information Section SR No. SOCIAL RESERVATION NAME 6. Education Details Section Naneof Naneof | Dateof [BaminationSex] Posing | Grade/Tota! | Obt Name of Board eco fxamination schootallege | Paning | Number [erate No| Marks | Marke vse nacaseconmuny | MOMRAMHCH oypgaons wo | a bq o anon 7, Gualitying Exam Detal Section QUALIFYING EXAM NAME: Xi Coleg School ‘mission | Passing | Marks | Total | etuction Attended cna Year Year | ott. | Marts [orcmtasep ise Gap ae oe ee 0 Qualifying Exam Subject Details [Link]. Subject Name Total Marks Obtained Marks 1 eNGusH 100 a 2 EDUCATION 100 16 3 istoRy 10 a ‘ POL SCIENCE 10 0 7 rou 10 a8 8. Subject Details Section [Link]. Group Name Subject Name Subject Code 1 ABILITY ENHANCEMENT COURSE (AEC COMPULSORY ENGLISH 2 ‘COMMON VALUE ADDED COURSE (VAC) CONSTITUTIONAL VALUESENVS 3 DISCIPLINE SPECIFIC CORE COURSE MAJOR) eNGUSH 4 nor EDUCATION URDU s SLL ENHANCEMENT COURSE SEC) eNoUSH 9. Attached Documents SrNo. Name of Documents/Certificate 3 (CLASS x BOARD MARKSHEET10. Guardian / Parent Information Section Guardian's/ Parent's Name: MAHFOOZ ALAM ‘Occupation of the Guardian/Parent: OTHER ‘Annual Income of the guardian/Parent: 000.00 Relationship of Guardian with applicant: FATHER Guardian/Parent Phone No: 9903327745 11. Other Information Section Mother Tongue: URDU. Employment Status: NO Do you wish to join NCC / NSS: NO ‘Would you lke to apply for Hostel: NO Hobbies, Proficiency and Other interests: NA Games and sports participation: Identification Mark 1: — Identification Mark 2: ~ 12, Declaration by Student | hereby declare that, | have read the rules related to admission and the information filed in by me in this form is accurate and true to the best of my knowledge. | will be responsible for any discrepancy, arising out Of the form signed by me and | undertake that, in absence of any document the final admission will not be granted ‘and/or admission wil stand cancel Place: Aiman Mahoo3 Date: Signature of Student 13, Declaration by Guardian / Parent Ihave permitted my son / daughter / ward to join your college. The information supplied by him / her is correct to the best of my knowledge. | have acquainted myself with the rules and fees, dues to my son/daughter/ward and see that he/she observes Place: Date: Signature of the Guardian/Parent 14. For College / Institute Use Only Designation Remarks / Particular / Recommendation Signature and Date Admin Clo Admission Committe Accountant cashier Resisro/Offce superintendent TTensacton Detals Payment Mode: OFFLINE Cash Received 0 ‘Transaction DNAREMARK OF THE ADMISSION COMMITTEE May be admitted to Class Section, May be Rejected, Last date of payment of fees ‘Admission may be cancelled if the fees are not paid by this date Principal Signature of Admission Committee Date: