University of Kalyani

P.O. Kalyani, Dist-Nadia

Pin-741235,West Bengal
CATEGORY

GEN

SC

ST

Total Marks Obtained (H).Out of......

Registration K.U. No.

PH

For: K.U/Other University

Recent Passport
Size
Photograph

APPLICATION FORM
FOR
ADMISSION TO 2-Year M.A/M.Sc./M.Com. /1-Year Certificate Course in Russian Languages/1-Year P.G
Diploma Course in Russian Language/Adult Education Course at University Department
In(Subject/Discipline) Session..
Space for Office Use

For Open Seats:

% of
Marks
Obtained

Score

10th
10+2(Best
Five)
Hons.
Total Score

1.

Name in Full of the Applicant (Block Letter) (To be spelt according to school leaving certificate)
.
Surname

Name

2.

(a) Fathers Name (in full) ..

Address

(b) Mothers Name ( in full).

Address

3.

Guardians Name (in full)...

Relationship.
Address

4.

Mailing Address (in block letters)...............................

....
Phone No. (if any)..E-Mail........................................................................

5.

Academic Records:
Examination Passed &
the name of the
Board/University

Year

Subjects Taken

Full
Mark

Mark
Obtained

% of
Marks

Duration
of Course

B.A/B.Sc/B.Com
(10+2) or Equivalent
10 or Equivalent

6.

Reason for gap, if any, after passing the B.A/B.Sc.(Hons.) Examination

.....
.

7.

Place of BirthDistrictState..

8.

Date of Birth : D D

Y Nationality Marital Status.

(according to school leaving certificate)

9.

Y
Y
Candidates financially supported by Father/Guardian
Y
Y

Source of Income

Amount of Monthly
Income

Total Income of the

Family (Monthly)

10. Name of the Institution where the candidate attended last/is attending:
Course of Study indicating the session

Year of Leaving

11. Whether a student of this University or any other University/Institution at present (Yes/No)
If Yes, give details ..
..
..
12. Voucher NoBank NameDate. DD / MM / YYYY

Amount ..

Note: (i) NONE IS ELIGIBLE TO STUDY TWO DIFFERENT COURSES SIMULTANEOUSLY IN THE SAME
ACADEMIC SESSION.
(ii) STUDENTS ADMITTED TO THIS UNIVERSITY SHALL HAVE TO PRODUCE WITHIN THREE
MONTHS THE MIGRATION CERTIFICATE OF THE UNIVERSITY FROM WHICH THEY HAVE
PASSED THE EXAMINATION QUALIFYING FOR ADMISSION.
(iii) CANDIDATES DESIROUS OF APPLYING UNDER SPORTS QUOTA SHOULD APPLY IN A
SEPARATE FORM AVAILABLE ON OUR WEBSITE.
(iv) ATTESTED COPIES OF ALL MARK-SHEETS BEGINNING FROM S.F. OR EQUIVALENT, PROOF
OF AGE, CHARACTER CERTIFICATE TO BE ATTACHED ALONG WITH THE STIPULATED
DATE .
(v) MEDIUM OF INSTRUCTIONS AND EXAMINATIONS ARE ENGLISH AND BENGALI.

DECLARATION

I declare that the particulars furnished by me are correct to the best of my knowledge and belief . I
declare that I shall abide by the rules of the University any statement being detected to be untrue,
at any point of time my admission shall be cancelled forthwith.

Counter Signature of the Guardian

Full Signature of the candidates

Date:

Date:

Place:

Place:

Received

Application

Form

against

Voucher

No...from

Shri/Smt.M.A/M.Sc./M.Com. /1-Year
Certificate Course in Russian Languages/1-Year P.G Diploma Course in Russian Language/Adult Education Course at University
Department infor the session 2012-13.

Signature with departmental seal

of the Receiving Assistant