Dwijendralal College

Roll & No.(As per H.S.) *

Passing Year *

Stream *

Board or Council *

If others *

Applicant First Name *

Applicant Middle Name

Applicant Last Name *

Date of Birth *

Gender *

Caste *

Blood Group

Physically Challenged *

Physical Disability Type *

Religion *

Minority *

Nationality *

Student Annual Family Income (in INR) *

EWS *

Is Player *

Banglar Shiksha ID

Kanyashree ID

Father's First Name *

Father's Middle Name

Father's Last Name *

Father's Education Qualification *

Father's Occupation *

Father's Mobile No. *

Mother's First Name *

Mother's Middle Name

Mother's Last Name *

Mother's Education Qualification *

Mother's Occupation *

Mother's Mobile No. *

Guardian First Name *

Guardian Middle Name

Guardian Last Name *

Guardian Mobile No. *

Relation *

Present Address

Country *

State *

District *

P.S *

Block *

Panchayat/Municipality *

Vill/Road/Lane/Street *

P.O. *

Pin *

Permanent Address

Country *

State *

District *

P.S *

Block *

Panchayat/Municipality *

Vill/Road/Lane/Street *

P.O. *

Pin *

Check the box if Permanent Adress is same

Contact Details :

Mobile No *

Whatsapp Number

Email ID *

Name of Subject	Total Marks	Pass Marks	Marks Obtained

Best Four Marks

Best Four Marks %

DECLARATION

a) I wish to apply for admission to the college and declare that all the above particulars are true to the best of my knowledge and belief. I agree that acceptance of this application does not confer on me in respect of selection for admission, which will be subject to institutional guidelines.

b) I do declare that I am fully aware of the anti-ragging approach of Dwijendralal College. I shall neither indulge in ragging activities nor shall take part in or subject anyone to ragging. If found guilty I shall be liable to statutory punishment.

c) I, further declare that, my admission may be cancelled, at any stage, if I am found ineligible and/or the informations provided by me are found to be incorrect.

I Accept