Serial No……………. Cost of the Form Rupees Twenty need to be paid along with the Examination fee.

U N I V E R S I T Y O F C A L C U T T A

APPLICATION FORM

[Applicable item should be ticked ( √ ) ]

TO

THE CONTROLLER OF EXAMINATIONS, UNIVERSITY OF CALCUTTA Sir,

I request permission to present myself at the ensuing examination for …………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………in …………………………………………………………………………………………………………… ** The Fees of Rs. ………… for the said Examination, and Rs………………… as centre fee are forwarded herewith.

If any of the statements made in the application be found to be not true, or if it appears that in the opinion of the University, I have in any way contravened the provisions of the University Rules and Regulations relating to the examination, my admission to the examination will be liable to be cancelled by the University. Yours obediently,

Signature of the candidate in full :……………………………………………………

DATE : Address :……………………………………………………. ……………………………………………………. Phone No:……………..…… Mobile No:………………………………………...…………..

DECLARATION OF THE HEAD OF THE INSTITUTION / DEPARTMENT / AUTHORISED SIGNATORY ***

I certify that the abovementioned candidate has satisfied me, by production of his/her Diploma, that he/she has passed the requisite examination as stated in the relevant regulation and has qualified himself/herself for admission to the Examination as stated in Column 4; that he/she has diligently and regularly prosecuted his/her studies as stated below in the as required under the Regulations; that his/her conduct has been good; that I know nothing against his/her moral character; and that I believe the subjoined account to be true.

(For Regular Candidate:- I further certify that he/she has produced the annexed certificate that he/she has taken a practical course of training for the period as prescribed in the University Regulations in the subject in which he/she desires to be examined. )

PERIOD OF REGULAR STUDY SINCE ADMISSION TO THE COU RSE (FOR REGULAR CANDIDAT ES ONLY)

DATE: …… / …… / 20…

* Admit Card for a regular Candidate with condonable shortage in attendance will be issued only on production of condonation order of the appropriate Calcutta University authority and

short Percentage condonation fee deposit challan. For External Candidates Admit Card shall be delivered only from Computer Document Cell, Result (Minor) Section, Centenary

Building, 6th floor, C.U. on production of fee deposit challan in original.

** The fees may be paid by demand draft drawn in favour of University of Calcutta on any clearing Bank in Kolkata. The amount paid as Examination fees shall not be

refunded.

*** For external candidate this declaration is to be given by any of the following under his/her seal and signature:(i) Member of the Senate, (ii) District Inspector of Schools,

(iii) University Inspector of Colleges, (iv) the Secretary of Faculty Council for P.G. Studies concerned, (v) Calcutta University Teacher, (vi) Principal of a College affiliated

to this University, (vii) Gazetted Officer.

Name of the College/ University Dept. in which the candidate has studied

Date of admission to the

course

Period of regular study

Category

Collegiate or Non - Collegiate

Paste recent stamp size

colour photograph

Roll No

(if any) …….…….…….…….…….…….…….……. Registration No under Calcutta University

…………………………..…….…….…….… of 20……. - 20…….

Challan

No…………….

Counter

No………….....

COURSE

B.A.LL.B. LL.M. M.L.I.S.

B.B.A. M.A. M.Mus.

B.Ed. M.A./M.Sc. M.P.Ed.

B.FAD. M.B.A. M.P.S.M.

B.L.I.S. M.B.M. M.Phil.

B.P.Ed. M.C.A. M.Sc.

B.Tech. M.Com. M.Tech.

B.V.A. M.Ed. M.V.A.

B.F.A. M.H.R.M. Diploma

Certificate M.H.R.O.M P.G. Diploma

Amount ……….

Date…………...

NAME OF THE EXAMINATION: ……………………………………………………………………………………………………..……… PART / SEMESTER ………………………………………………………………………………………… YEAR: ………………………

Signature of the Head of the Department /

Principal / Authorised Signatory …………….………………………………………

Official Designation with Seal …………….………………………………………

[1]

2. 3. SEX

Male Female

STUDENT CATEGORY

Regular External

ENROLLMENT CATEGORY

ANNUAL PART

SEMESTER

SUPPLEMENTARY

Part I

Part II

Sem I

Sem II

Sem III

Sem IV

Sem V

Sem VI

Sem VII

Sem VIII

Sem IX

Sem X

1.

5. 6. (a)

7.

4.

9.

10.

Back candidate

As a whole Supplementary Paper(s)

6. (b)

8.

( T O B E F I L L E D I N B Y T H E C A N D I D A T E )

N.B: Omission to furnish any of the information asked for below will make the admission of the candidate to the examination liable for cancellation without notice.

11. Name in Full …………………………………………………………...………………………………………………………....…… (In Block Letters and as per Registration Certificate of C.U. )

12. Date of Birth (dd/mm/yyyy): ……………………………………………..……………………………… ……………………………... 13. Address

Permanent : ……………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………

Present : ………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………

14. Son/ Daughter of …………………………… …………… Guardian’s Name (If necessary)…………………………………… ……..

15. a) Nationality: ............................................................................ b) Category: General SC ST OBC PH

16. Details of the previous qualifying examination passed: ………………………………………………………………………………………

Year University/

Board/Council Examination Roll Number Subjects passed

17. Whether permitted by the Secretary of the Faculty Council Concerned to appear at the examination as an external candidate: Yes No

If yes whether permission letter enclosed with this form (In case of external Candidate): Yes No

18. If previously appeared at the Examination (Column 4) Yes No

(If yes then fill up the following table and enclose photo copy of all previous mark sheets) State marks/grade obtained at the previous Examination (as stated in Column 4) together with Roll Number……………………..………………

…………………….. …………………….. year……………….

[ATTA CH XE RO X COPY O F MARK SHEETS OF ALL PREVIO US P A RT O R SEME STER E XA MIN ATIO N]

19. Whether he/she has migrated from other University; if so, the number and date of the Registrar’s letter sanctioning his/her migration should be stated and the

photocopy of the sanction letter should be attached along with.

(a) Number………………………………….. (b) Date ……………………………………………….. 20. Whether he/she was debarred from appearing at a University Examination for any year or years on a charge of breach of discipline ; if so state :-

(a) Name of Examination (with year) in which he/she was reported against ……………………..........................................…………..…………

Part …………………………Year……… ……………… (b) Roll……………………… No…………………………..……… (c) Registration No………………………………….of…………………………………………………………………………………

(d) Year or years for which debarred……………………………………………………………………………………………………….

21. Name of the Course(s)/Group or Special or Elective Paper in which he/she desires to be examined .

Course/s Group/s Spl.Paper/s Elective Paper/s

Group/s Group/s

22. Title of Dissertation (if any)………………………………………………………………………………………………………………

DATE: …… / …… / 20… Signature of the Candidate in full …………………….……………..

[2]

Part/Semester

With year

Course/

Paper

Course/

Paper

Course/

Paper

Course/

Paper

Course/

Paper

Course/

Paper

Course/

Paper

Course/

Paper

Course/

Paper

Course/

Paper

Total

Marks/SGPA

Result

(Copy of certificate to be enclosed for SC/ST/OBC/PH cases)

23.

( T O B E F I L L E D I N B Y T H E C A N D I D A T E )

[Applicable item should be ticked ()]

N A M E O F T H E G R O U P /C O U R S E S / E L E C T I V E / S P E C I A L PA P E R S I N W H I C H T H E CA N D I D A T E D E S I R E S T O B E E X A M I N E D : -

Course/s Group/s Spl.Paper/s Elective Paper/s

Group/s Group/s

Title of Dissertation (if any) ……………………………………………………………………………………………………………………………………………….

DATE: Full Signature of the Candidate …………………….…………………..

VERIFIED WITH THE APP LICATION FORM AND FOUND TO BE CORRECT Signature …………………… …………………… ……………………… WITH DATE DEALING ASST. JR. SUPDT. SR. SUPDT.

[3]

Registration Number under Calcutta University …………………………..…….…….…….…………….…….…….……… of 20……. - 20…….

Name of the College / University Department in which the candidate

studied ………………………………………………………………………

Name in Full ………………………………………...

(In Block Letters and as per Registration Certificate of C.U. )

Son / Daughter of …………………..………………. (In Block Letters)

SEX

Male Female

STUDENT

CATEGORY

Regular External

CATEGORY

GEN SC ST OBC PH

NAME OF THE EXAMINATION: …………………………………………………………………………………………………………. PART / SEMESTER ………………………………………………………………………………………… YEAR: ……………………

Roll No. allotted in previous (Part- I / Semester- I Examination, if any) (in case of Semester-I or Part-I, this should be left blank)

Roll No Part/Semester Year

…………………………..…….…….…….…………….…….…….………

SIGNATURE WITH DATE:

A.

B.

C. (i)

D. E.

F.

G.

H

.

COURSE

B.A.LL.B. LL.M. M.L.I.S.

B.B.A. M.A. M.Mus.

B.Ed. M.A./M.Sc. M.P.Ed.

B.FAD. M.B.A. M.P.S.M.

B.L.I.S. M.B.M. M.Phil.

B.P.Ed. M.C.A. M.Sc.

B.Tech. M.Com. M.Tech.

B.V.A. M.Ed. M.V.A.

B.F.A. M.H.R.M. Diploma

Certificate M.H.R.O.M P.G. Diploma

C. (ii)

1. Door No. …………………………… 2. Street …………………………………………………………………… 3. Village/City …………………………..... 4. Post Office ……………………………………..5. Police Station ………………………………………… 6. District ………………………………………. 7. State ………………………………………… 8. PIN 9. Phone Number 10. Mobile

Address:

I.

ENROLLMENT CATEGORY

ANNUAL PART

SEMESTER

SUPPLEMENTARY

Part I

Part II

Sem I

Sem II

Sem III

Sem IV

Sem V

Sem VI

Sem VII

Sem VIII

Sem IX

Sem X

Back candidate

As a whole Supplementary Paper(s)

(The applicants are instructed to read the instruction manual carefully and to tick () the appropriate boxes in the form and as well as in this

sheet too. The Form must be filled in with legible handwriting and block letters must be used wherever required. The serial numbers in this page

refer to the subsequent coloumn numbers in the form. Omission to furnish any of the information asked for below may make the admission of the

)candidate to the examination liable for cancellation without notice.

1. The Challan number, Cash Counter number, amount deposited and the deposit date are properly mentioned.

2. The category of the student, whether External or Regular is ticked.

3. The Sex of the applicant is properly marked in the appropriate box.

4. The exact name of the Examination is same as the name of Examination printed in the Notice of Form fillup.

5. The appropriate stream of the Examination is ticked.

6. (a) Appropriate Part/Semester of the Examination is ticked.

(b) Whether Theoretical or Practical papers for Old candidates or all the papers as a whole for new candidates is ticked.

7. Previous Roll and Registration number allotted by the University (if any) is stated properly.

8. The fees to be mentioned properly.

9. The exact name of the Examination with year (as stated previously in coloumn 4) along with Special

Paper(s)/Group/Thesis, Examination and Centre fees submitted (as stated in coloumn 1) is stated clearly.

10. For Regular Candidates only: Since admission to this course (as stated in coloumn 4), details of the period of regular

study are furnished.

Signature of the Head of the Department/Principal (for Regular candidates) or Authorised Signatory (for External

candidates) along with date and official designation with Seal is provided.

11. Full name of the applicant in block letters as per the Registration certificate of the University of Calcutta is written.

12. The date of birth (in dd/mm/yyyy format) is stated.

13. The Permanent address and the Present address are provided clearly.

14. Father’s/mother’s name is stated and the name of the local guardian (if necessary) is properly stated.

15. (a) The nationality of the applicant is stated.

(b) The category of the applicant, whether General/SC/ST/OBC/PH is properly ticked.

16. The details of the previous qualifying examination are properly stated.

17. For Non-Collegiate candidates only: Whether the applicant is permitted by the Secretary of the concerned Post Graduate

faculty to appear for the examination (as stated in coloumn 4) as non-collegiate candidate and whether the permission

letter issued to him/her is enclosed along with is ticked.

18. Whether the applicant previously appeared at the Examination (as stated in coloumn 4) is ticked.

19. If the applicant is migrating from other University, the number and the date of the Migration Certificate issued to him/her

is stated properly.

20. The details of whether the applicant was debarred from appearing at any University Examination for any breach of

discipline are furnished properly.

21. The details of Course/Group or Special or Elective Paper which the applicant desires to be examined together with the

Dissertation (if any) is provided.

22. The title of the Dissertation (if any) is mentioned properly.

23. Full signature of the applicant with date is provided.

A. Same as instruction number 4.

B. Same as instruction number 5.

C. Same as instruction number 6(a) and 6(b).

D. Same as instruction number 3.

E. Same as instruction number 2.

F. Same as instruction number 15 (b).

G. Previous Roll and Registration number allotted by the University (if any), name of the College/University department in which the applicant

studied, full name of the applicant along with his/her father’s/mother’s name in block letters are provided.

H. (From 1 to 10) The proper address and phone numbers are provided.

I. Name of the Group/Courses/Elective/Special papers in which the applicant desires to be examined is/are mentioned.

ACBS Accountancy and book keeping

ARBS Arabic

BNGS Bengali

CMSS Computer Science

ECOS Economics

EDCS Education

ENGS English

FARS Fine Arts (Drawing & Painting)

FNTS Food & Nutrition

GEOS Geography

HINS Hindi

HISS History

HMSS Home Science

HOMS Home Management

LFSS Life Science

LOGS Logic

MTMS Mathematics

MUSS Music

PEDS Physical Education

PHLS Philosophy and Logic

POLS Political Science

PSYS Psychology

PHYS Physical Science

SANS Sanskrit

URDS Urdu

WEDS Work Education

YES NO

A b b r e v i a t e d n a m e s o f s u b j e c t s i n B a c h e l o r o f E d u c a t i o n ( B . E d . ) C o u r s e