FormNo.

CU/NonCU
Honsin:
P.G.in:
Passed/Appeared
Intheyear:
Category:Gen/SC/ST/
OBCA/OBCB
PWDYESNO

MARKSINP.G.

OUTOFMARKSOBTD.

UNIVERSITYOFCALCUTTA

UNIVERSITYCOLLEGESOFARTS&COMMERCE
ApplicationFormforAdmissiontoM.Phil.CoursefortheSession:201416

1.NameofApplicant:
(AffixSRIMATIincaseoffemalecandidate)
2.CourseAppliedfor:MPhilin
3.C.U.RegistrationNo.:
4.Address:Present:...................
..

Permanent:__________________________________________________________________

__________________________________________________________________

ContactNo.:
Passport
sizephoto
pastehere
andsign

(ChangeofAddressorcontactNo.tobecommunicatedimmediately)

5.DateofBirth:
(accordingtoSchoolFinal/CBSE/ICSEExam.AdmitCard)

6.Nationality:
7.Occupation :
(ifalreadyemployed,employersNOC&monthlyincomecertificatemustbeattached)

8.StatementofMarksinPreviousExaminationsPassed:
ExaminationPassed

Madhyamik/CBSE/ICSE
H.S.
BA/B.Sc./BComPt.I(Hons.marksonly)
BA/BSc/BComPt.II(Hons.marksonly)
BA/BSc/BComPt.III(Hons.marksonly)
M.A./M.Sc./M.ComPt.I/Sem.I
M.A./M.Sc./M.Com/Sem.II
M.A./M.Sc./M.ComPt.II/Sem.III
M.A./M.Sc./M.Com/Sem.IV

Yearof
Passing

RollNo.

Division/
Class
obtained

Aggregate
FullMarks Marksobtd.

Totalof
Pt.I,II,III

Totalof
Pt.I,IIor
Sem.IIV

Declaration/Undertaking

I, ______________________ hereby declare that all the particulars stated by me in this Application Form are true and
correcttothebestofmyknowledgeandbelief.IhavereadtherelevantInformationBrochure&AdmissionScheduleand
advertisement for the course displayed on the University website/Printed Hard copy/Notice Board for Admission. I shall
abide by the terms and conditions therein. It is entirely my responsibility, to prove my eligibility for admission to the
programmetowhichIwillbeadmittedandalso,inrespectofqualificationsandentitlementforadmissionagainstreserved
category,ifclaimed,tothesatisfactionoftheUniversity.Further,intheeventofsuppressionordistortionofanyfactlike
category,educationalqualifications,nationality,etc.statedinApplicationForm.Iunderstandthatmyadmissionifgranted
or degree acquired subsequently, is liable to be cancelled. I also understand that the decision of University of Calcutta
regardingmyadmissionwillbefinalandIshallabidebytherulesandRegulationsofUniversityofCalcuttafromtimeto
time.

Place:
Date:

SignatureofGuardian

SignatureofApplicant

p.2

NameoftheApplicant:

ApplicationFeeRs.500/(Rs.250/forSC/ST/PWD)(DeposittoSBI,CUBr.CurrentA/cNo.33952775663under
theheadCalcuttaUniversityP.G.offlineapplication).PleaseattachCounterpartofCashDepositionreceipt
andwriteonthereverseName,Course(subject)appliedforandMobileNo.ofthecandidate.orDDinfavour
ofCalcuttaUniversitypayable atKolkata istobeattachedwiththeapplication form.IncaseofDD orcash
deposit payinslip please write on the reverse (a) Name of the applicant (b) Course applied (subject) for (c)
mobile number. No bank charge will be payable if cash deposition made in SBI, C.U. Br. at University of
Calcutta,CollegeSt.Campus.

PaymentDetails:
NameoftheBranchofSBI

Challan/Scroll/DDNo.

Dt.ofdeposit

ApplicationFee

SignatureoftheApplicant

Enclosures
1.
2.
3.
4.
5.

Counterpartofpaymentreceipt.
Selfattestedtruecopiesofmarkssheetsofalltheexaminationspassed(10thstandardonwards).
ProofofDateofBirth.
SC/ST/OBC(A)/OBC(B)/PWDCertificate,ifapplicable.
FamilyIncomeCertificate.

N.B.:Alloriginalsoftheabovedocumentsaretobeshownatthetimeofsubmissionofapplicationform.

Receipt

AnapplicationformforM.Phil.inhavingP.G.degreeinwithmarksof
_________outof..from(nameofstudent)hasbeen
acceptedbytheofficeforthesession201416.

Signature(Receivedby)