FromNo.

MARKSINHONOURS

OUTOFMARKSOBTD.

Category:Gen/SC/ST/OBCA
/OBCB
CU/NonCU
HONS.PASSED:2013/2014
PWDYESNO

UNIVERSITYOFCALCUTTA
UNIVERSITYCOLLEGESOFARTS&COMMERCE
ApplicationFormforAdmissiontoM.A./M.Sc.inEconomics
ApplicantsName:
Honourssubject:
General1
General2
University:
College

Passportsize
photo
pastehereand
sign

3(A)WhetheradmittedlastyearSubject:
(B)Ifyes,courseinwhichadmittedSelectionNo.

4.RegistrationNo.(Mandatoryforall)

Section:

5.StatementofMarksat(10+2)Level
Subject

VernacIar

English

1st Elec

2nd Elec

Marksobtd.

FullMarks

6.StatementofMarksinthelastqualifyingExamination
Examin
Yearof RollNo.
Honourssubject Pass
ation
Passing
(1)
Marks

BA/BSc/
obtd
BCom
Full
Pt.1
Marks

3rd Elec

RollNo.
4th Elec

Total(bestof5
incl2languages)

Pass
(2)

Pass
(3)

Aggregate
Hons. Pass

Marks

obtd
Full
Marks
Marks

BA/BSc/
obtd
BCom
Full
Pt.III
Marks
Totaloutof:Hons:GenPasssubjects:

ChoiceinorderofPreference
Subject(1)

(2)

(3)

(4)
ApplicationFeeRs.100/(Rs.50/forSC/ST/PWD)(DeposittoSBI,CUBr.CurrentA/cNo.33952775663under
theheadCalcuttaUniversityP.G.offlineapplication).PleaseattachCounterpartofCashDepositionreceipt
andwriteonthereverseName,CourseappliedforandMobileNo.ofthecandidate.
PaymentDetails:
NameoftheBranchofSBI
Challan/Scroll/DDNo.
Dt.ofdeposit
ApplicationFee

SignatureoftheApplicant

BA/BSc/
BCom
Pt.II

Receipt

AnapplicationformforM.A.inwiththeHonoursmarksofin
..from(nameofstudent)hasbeenaccepted
bytheofficeforthesession201416.

Signature(Receivedby)

PersonalInformationoftheApplicant

1.NameoftheApplicant:

2.DateofBirth:
3.(A)PresentAddress
(B)TelephoneNo.

MobileNo.
4.(A)PermanentAddress:
(B)TelephoneNo.

5.Email

6.State:
7.Nationality

8.Gender

9.MaritalStatus
10.BloodGroup

11.Religion
12.(A)FathersName

(B)Occupation
(C)MonthlyIncome
13.(A)MothersName:

(B)Occupation
(C)MonthlyIncome
14.(A)SpousesName:

(B)Occupation
(C)MonthlyIncome
15.(A)GuardiansName

(B)Occupation
(C)Relationship
16.Incomeofthefamilypermonth(Rs.)
17.Areyouenjoyinganyscholarshiporstipend
18.ExaminationPassed
Madhyamikor10Level
HigherSecondaryor(10+2)Level
YearofPassing

NameofSchool

NameofBoard

PercentageofMarks

N.B.ForWorkingJournalist:NameoftheJournal(withCertificate)
(incaseofAdmissiononMAinJournalism&MassCommunication)

Declaration/Undertaking

I,______________________herebydeclarethatalltheparticularsstatedbymeinthisApplicationFormare
true to the best of my knowledge and belief. I have read the relevant Information Brochure & Admission
SchedulepastedontheUniversitywebsite/PrintedHardcopy/NoticeBoardforAdmission.Ishallabidebythe
terms and conditions therein. It is entirely my responsibility, to prove my eligibility for admission to the
programme to which I will beadmitted and also,in respect of qualifications and entitlement foradmission
againstreservedcategory.Ifclaimed,tothesatisfactionoftheUniversity.Further,intheeventofsuppression
ordistortionofanyfactlikecategory,educationalqualifications,nationality,etc.madeinApplicationForm.I
understand that my admission if granted or degree acquired subsequently, is liable for cancellation. I also
understandthatthedecisionofUniversityofCalcuttaregardingmyadmissionwillbefinalandIshallabideby
therulesandRegulationofUniversityofCalcuttafromtimetotime.

Place:
Date:

SignatureofGuardian

SignatureofApplicant

Enclosures
1. Counterpartofpaymentreceipt.
2. Selfattestedtruecopiesofmarkssheetsofalltheexaminationspassed(10thstandardonwards)
3. ProofofDateofBirth
4. SC/ST/OBC(A)/OBC(B)/PWDCertificate,ifapplicable
5. FamilyIncomeCertificate