St.

Xaviers College (Autonomous)

Career Oriented Programme
30, Mother Teresa Sarani (Park Street), Kolkata 700 016
Phone: +91 33 2255 1288/89, e-mail: careersxc@gmail.com
ADMISSION FORM FOR THE SESSION JULY 2014
PHOTOGRAPH
Affix your
latest
passport size
photograph
Admission Status:
___________________________________________________________________________
Name of the Candidate
Name of Parent/Guardian
Date of Birth
Gender Category
Mobile number of the Candidate Mobile number of Parent/Guardian
Religion Category
Course: NSE Certified Capital Market Professional (NCCMP)
Address for Correspondence (Leave a blank between each unit of address House No. Street Name, PO, etc)
City/District State
Pin Code/Zip Code
Telephone (with STD Code)
E-mail Address
Permanent Address (Leave a blank between each unit of address House No. Street Name, PO, etc)
City/District State
Country Pin Code/Zip Code
Self/Family Income (p.a.)
Page 1 of 2
Form No. Roll No.
Male
Female
GEN
ST OBC
SC Christianity (RC) Hindu Sikh
Muslim Christianity (XT)
Buddhist
Others Jain
O+
O- A-
A+ B+
B- AB-
AB+
BATCH- II (Tue, Thu, Sat: 1:30pm-3:30pm)
BATCH- I (Mon, Wed, Fri: 6pm-8pm)
W
Declaration/ Undertaking
I solemnly affirm that the particulars given above are true and no information has been deliberately
concealed.
I agree to abide by the rules of the college and directives given from time to time.
I shall not be entitled to refund of any fee paid by me to the college.
Date:
Place: Signature of the Candidate
Check List for admission
Registration fee of `100/- in cash
Date of Birth Proof (self attested photocopy)*
2 Copies of Passport Photograph (one each to be pasted on Admission Form and ID Card Form)
Qualifying Marksheet (attested photo copy)*
Duly filled up printed copy of admission form
Duly filled up printed copy of ID Card Form
Category Certificate for ST/SC/OBC (attested photo copy)*
* Original Documents are to be shown for verification at the time of Admission
Fees Payment Instruction
Fees can be paid by cash/Demand Draft/Pay Order.
Fees in cash are to be paid at the counter of the Syndicate Bank on the college premises from 9am. to 1pm. (weekdays),
9am. to 11am ( Saturdays) [please attach a photocopy of the paid Bank Challan with the form.]
Demand Draft/Pay Order for Course Fees to be prepared in favour of St. Xaviers College, payable at Kolkata [please write
your Name & Course backside of the Demand Draft/Pay Order and also keep a photocopy of the Demand Draft/Pay Order]
Page 2 of 2
Details of Completed Educational Qualifications
Qualification Examination Name, Institution Name, City Stream/Honours Year of Passing Grade/ Percent
Intermediate/10+2
Graduation
Post Graduation
Details of Currently Pursuing Educational Qualifications
Qualification Examination Name, Institution Name, City Stream/Honours Roll No
Year of
Appearing
Details of Employment, If Any
Name of Present Employer (with address and Contact No.) Designation Experience
CAREER ORIENTED PROGRAMME(COP)
COLLEGE I.D. CARD FORM
St. Xavier's College (Autonomous)
30, Mother Teresa Sarani, Kolkata 700016
Phone : 22875995/22551288
Website : www.sxccal.edu
PHOTOGRAPH
Affix your
latest
passport size
photograph
Name of the Candidate
Name of Parent/Guardian
Mobile number of the Candidate
Address & Correspondence (Leave a blank between each unit of address House No. Street Name, PO, etc)
City/District State
Country Pin Code/Zip Code
Telephone (with STD Code)
E-mail Address
Blood Group
Signature _____________________________________________________
Date of Birth
Roll No.
Course NSE Certified Capital Market Professional
Session July 2014 - February 2015
CAREER ORIENTED PROGRAMME
St. Xaviers College (Autonomous)
30, Mother Teresa Sarani, Kolkata - 700016
Date: ....................................
Demand Draft/ Pay Order No. ................................
STUDENTS COPY
Paid to the credit of St. Xaviers College A/c No. 95852010004418 as per details above
Name of the Candidate
Payment Details Payment Type
CAREER ORIENTED PROGRAMME
St. Xaviers College (Autonomous)
30, Mother Teresa Sarani, Kolkata - 700016
Date: ....................................
Demand Draft/ Pay Order No. ................................
INSTITUTIONS COPY
Paid to the credit of St. Xaviers College A/c No. 95852010004418 as per details above
Name of the Candidate
Payment Details Payment Type
CAREER ORIENTED PROGRAMME
St. Xaviers College (Autonomous)
30, Mother Teresa Sarani, Kolkata - 700016
Date: ....................................
Demand Draft/ Pay Order No. ................................
BANKS COPY
Paid to the credit of St. Xaviers College A/c No. 95852010004418 as per details above
Name of the Candidate
Payment Details Payment Type
Verified by:________________________ Cashier:________________________
Verified by:________________________ Cashier:________________________
Verified by:________________________ Cashier:________________________
Course NSE Certified Capital Market Professional Session 2014-15
Amount
Amount
Amount
Roll No.
Course NSE Certified Capital Market Professional Session 2014-15 Roll No.
Course NSE Certified Capital Market Professional Session 2014-15 Roll No.
Full Payment 1st Installment
2nd Installment 3rd Installment
Cash
Demand Draft/ Pay Order
Full Payment 1st Installment
2nd Installment 3rd Installment
Cash
Demand Draft/ Pay Order
Full Payment 1st Installment
2nd Installment 3rd Installment
Cash
Demand Draft/ Pay Order