1.   Name of the Applicant in Block Letters *-   

(Miss or Mrs. in case of Women)

2.   Name of the Father/Husband of the Applicant *-   

a) Occupation* -   

b)Total Annual Income* -   

3.  Name of the Guardian, if the father is
is not alive/Name of local Guardian
and Address with Police Station & Phone No. -     

4. a) Permanent Home address with         Rly. Stn./Police Stn.*

b) Nationality*- 

c) Religion *- 

d) Gender*-       Male Female

e) Category-       GEN SC ST OBC-A OBC-B

f) Physically Challanged-       PH

5.  Residence in Kolkata or Present Address* -     

5.  Gurdian Official Address* -     

a) Mobile No* -  b) Landline No* -    c) Guardian Contact No*-   

d) Gurdian Official Contact No*-    e) Email ID-*   

6.  Date of Birth(DD/MM/YYYY)-

7. Whether the applicant has joined any other course of    study of this University or any other University/Institute -

8.  Calcutta University Regn. Number-         & Year-   

9. Whether Participated in any extra academic activities and   sports.If so, details thereof (Attested copy of Certificates to be)

10. Course Type* - Pass

11.  Whether employed. If so state name & address
of the employer,(if employed later on the
information must be given immediately) -