TAMRALIPTA MAHAVIDYALAYA

Form No.
TAMLUK :: PURBA MEDINIPUR
NAAC Accredited ‘A’ Grade College Subject:
Roll No.:
APPLICATION FORM Session: 2019-2020
For admission to M.A./M.Sc./Other Courses

To Affix recent
The Principal passport size
Tamralipta Mahavidyalaya coloured
Tamluk, Purba Medinipur. photograph
PIN – 721636.

Sir,
I beg to apply for admission to the Post-Graduate Course in …………………………………………… as a
regular student for the session 2018-2019. (Subject)

Yours faithfully,

…………………………………………….
Signature of the applicant
Date:………………………….

1. Name (in block letters) :

2. Father’s /Spouse’s Name :

3. Mother’s Name :

4. Statement of Marks obtained at different examinations :

Name of the Board/Council/ Subject(s) Year of Total Marks Percentage Div./

Examination University Passing Marks obtained of Marks Class
(1) (2) (3) (4) (5) (6) (7) (8)
Madhyamik or
Equivalent

H.S. or Equivalent

B.A./B.Sc./
Hons. in …………..

5. Date of Birth :

6. Permanent Address :
(with PIN code & Telephone/Mob. No.)

7. Whether SC/ST/OBC-A/OBC-B /PWD : Gen SC ST OBC-A OBC-B PWD

Pl. tick the appropriate box
8. Whether Persons with Disability (PWD)
Yes No
(if yes, then PWD%…….
Category of PWD……)

9. Claim for (sports/culture) Quota :

(if yes, then mention level: International/National/ Yes No
State with supporting documents)
10. Whether willing to appear at Entrance Test (Open Competition): Yes /No

Yes No

11. Sex :
Male Female
12. (i) Father’s /Mother’s/Spouse’s annual income :
(ii) If BPL category, pl. attach certificate :
13. Nationality :
14. Religion :
15. (i) Registration No. of this University : No……………… Year ………………

(ii) Name & Registration No. of the University :

last attended
(In case of student migrating from other University)
16. Any other information
(with supporting documents) :

DECLARATION BY THE STUDENT

1. I do hereby declare that (a) all items of information provided in this form are true to the best of my
knowledge and belief. If proved otherwise, I shall be punished as per rule; (b) I shall be a bonafide
student of the institution and I shall not be engaged in any employment or any other work or course
of study elsewhere during the course for which I am applying. If proved contrary, my admission shall
be liable to be cancelled; (c) If any of the above statements is incorrect or if it is found that I have in
any way contravened the provision of the rules and regulations relating to the eligibility for
prosecuting Post Graduate study or relating to the eligibility for taking the University Examination
after such study, my admission will liable to be cancelled and I shall not be entitled to get refund of
fees paid by me; (d) I bind myself to abide by the code of conduct and discipline as may be enforced
by the authorities from time to time; (e) If I do not attend lectures for 10 (ten) consecutive teaching
days from the date of commencement of classes without prior information and valid reasons, my
admission will be treated as cancelled; (f) I shall attend at least 75% of the total classes held in all
Semesters.

2. I do hereby undertake that (a) I will not indulge in any behavior or act that may come under the
definition of ragging; (b) I will not participate in or abet or propagate ragging in any form; (c) I will not
hurt anyone physically or psychologically or cause any other harm; (d) I hereby agree that if I am
found guilty of any aspect of ragging, I may be punished as per the provisions of the UGC
Regulations and/or as per the law in force.
………………………………………
Signature of the applicant with date
 DECLARATION BY THE PARENT/GUARDIAN

1. I declare that (a) information given by my ward is correct; (b) In the event of his/her being admitted
to the institution, I shall pay all his/her dues, if any, till the completion of the course.

2. I do hereby undertake that (a) my son/daughter/ward will not indulge in any act of ragging; (b) if
he/she is found guilty of any aspect of ragging, he/she may be punished as per the provisions of
UGC Regulation and/or as per the law in force.

……………………………………………….
Signature of father/mother/guardian with date

OFFICE USE

Roll No.:
ADMITTED

Compared
Principal
Tamralipta Mahavidyalaya
Signature of H.O.D./Course Co-ordinator

Form No.

Received an Application Form from ……………………………………………………….. for admission to

M.A./M.Sc. in …………………………….……………………of Tamralipta Mahavidyalaya for the
session 2019-2020. (Subject)

……………………………………………………
Date: ………………… Signature of Receiving Assistant
& Office Seal
Past your recent
passport size
photo if you are
willing to seat
the Entrance
test for 40%
seat.
No separate information will be sent to the candidate. The Merits Lists of the candidates for the
different courses will be displayed on the Notice Board of the Tamralipta Mahavidyalaya and
website specifying the date(s) for counselling and admission. Counselling and admission will be
held on the same day.

Any one failing to get himself/herself admitted on the specified date for any reason whatsoever will lose
his/her right to admission and the vacancy will be filled up from the Merit List on the date of counselling.

List of Documents to be sent to Tamralipta Mahavidyalaya

1. Application Form (PAGE-1, PAGE-2 and PAGE-3)

2. Self Attested Copy of all Marks Sheets
3. Self Attested Copy of the Graduation Registration Certificate
4. Self Attested Copy of the Birth Certificate (Ex. Madhyamik Admit)
5. Self Attested Copy of the SC/ST/OBC-A/ OBC-B/ Minority Certificate (If applicable)
6. Self Attested Copy of the PWD Certificate (If applicable)
7. Self Attested Copy of the Sports/Cultural Certificate (If applicable for Sports/Cultural quota)
8. Self Attested Copy of the BPL Certificate (If applicable)
9. Supporting documents (If applicable for any other information)

……………….