7/27/2019 Admission Form Dde 2013

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Pin.DIST.

THE UNIVERSITY OF BURDWAN Form No.Directorate of Distance Education

ADMISSION FORM FOR M.A. / M. Sc. / M.Com. Courses

Session : 201__ - 201__ Offered Through Distance Mode

Affix self signedStamp size

recent colourphotograph

here

(for Office use only)

(for Office use only)

Enrolment No. AlottedDDE / / 201__ /TO BE FILLED IN BLOCK LETTERS

(Use Blue or Black Ball Pen)

Exam Centre :

Exam Centre :

M.A. M.Sc. M.Com.or or

Name of Applicant :

(Burdwan / Malda / Coochbehar/Birbhum/Bankura)

(Burdwan / Malda / Coochbehar/Birbhum/Bankura)

[Strictly as in SF/Madhyamik/Secondary Exam. Admit Card]

Signature of Receiving PersonnelDirectorate of Distance Education

The University of BurdwanDate : DD / MM/ YYYY

RECEIPT

(To be filled in by the candidate)

(To be filled in by the candidate)

Form No.

Full signature of Student

STUDY MATERIAL ISSUED SLIP Form No.

Study Material received by (Name of the Applicant )

for the M.A. / M. Com. Part-I Courses or M.A. /M.Sc. Sem. I & II/M.Sc. Sem I in

for the Session 201_ - 201_ Study Material due, if any ____________________________.Date :

Fees may be deposited through Power Jyoti Account No. 32868998865 in any SBI Branch

Any change of Address / Mobile no. should be communicated immediately.

Note : The form may be liable to be treated as cancelled if it is not complete in all respects, the specified document of the ful l course fee paid is not attached, the attested photograph is not affixed, and the required copies of credentials are not enclosed

E-mail :

Mobile No :

Sex :

Father's Name/Husband's Name :

Mother's Name :

Mailing Address :

Address

C/o

STD Code & Telephone No.(Mandatory)

Caste :

Received from ( Name of the Applicant ) one Admission Form

along with Challan / Demand Draft No. Date Amount ` for the M.A. /M. Com. Part-I Courses or M.A. / M.Sc. Sem. I & II/M.Sc. Sem I in

DD / MM/ YYYY

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D D M M Y Y Y Y

M F Marital Status : M ae d r r i

U n r e

d m a

r i Gen OBC SC ST

(Please )P

(Please )P

(Please )P (Please )P

Code :

Subject :

Gen-04 OBC-01 SC-02 ST-03

(Please )P

(Please write)

n n n

n n n

Yes No(Please )P

Physically Handicapped : Employed Unemployed Rural Urbann n n Nationality : I n d i a n

o ir

F r eg n e

(Please )P

or or or(Please )P (Please )P

Land Line No :(If any)

0 0

(Special Paper only for Philosophy

(Special Paper only for Philosophy)

(Special Paper only for Philosophy)

SUBJECT

SUBJECT

Sl. No. of S.M. :

(for Office use only)Sl. No. of S.M. :

Write any one

Write any one

DD / MM/ YYYY

for the Session 201_ - 201_

Bank Journal No.(See at Bank Challan)Date :

Amount : `

7/27/2019 Admission Form Dde 2013

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(i) This Receipt should be carefully preserved.

(ii) It has to be produced/submitted as and when advised.

(iii) Form must be submitted personally and obtain the Receipt and the Study Material,

(iv) Except University Authorize Study Center this University does not recognize any 'Outside Agency' candidateschoosing to process their admission formalities through any such Agency or Centre will do that at their own risk andresponsibility. The University will in no case be responsible if they do not receive Study Materials / PCPletter./Marksheet etc. Through such arrangement made by themselves.

N.B.

Declaration of the candidateI declare that the particulars given above are true to the best of my knowledge and belief. I give undertaking that my admission will stand cancelledif it is discovered that I do not have the minimum qualification or the information supplied by me is false. I agree to abide by the rules andregulations of the course. I further declare that I shall submit to the disciplinary jurisdiction of the authorities of the University, who may be vested

with the authority to exercise discipline under the Act, Statutes, Ordinances, Regulations and Rules of the University.

Signature of the dealing personnelFull Signature of the Student

(Name /Spelling must be as written above)

Burdwan University Registration No. :(applicable only for B. U. Student)

Date of Birth :

Name of the University last attended :

Academic qualification from SF/Madhyamik onwards(Attach self signed photocopies of Marksheet)

Hons.

Hons.(Pass)3 Year (Pass)

Spl. B.A.Bridge

M.A.

Name of theBoard

Year of Passing Subjects Studied Total Marks

MarksObtained % of Marks DivisionExam passed

S.F/Madhyamik or equivalentexam.

H. S. or equivalent

exam.

Exam. PassedPlease 3

Name of theUniversity

Year of Passing Subjects Studied

Total Marks of theRelevant Subject

MarksObtained in it

%of Marks

FinalResult

Date of commencement of the course Exam., to be held on & from

Whether doing any other courseduring the session. If yes, give detailof the course

UniversityDuration Name of the courseWrite Yes/No

of

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