RECEIPT NO: St. Xavier s College (Autonomous) Career Oriented Programme 30, Mother Teresa Sarani (Park Street), Kolkata 700 016 Phone: +91 33 2255 1288/89, e-mail: career@sxccal.edu ADMISSION FORM FOR THE SESSION JULY 2015 Course: For Office Use ROLL NO: STATUS Instruction: This is a fillable form, you can fill up the form and print the completed form. (Initials not allowed) Name of Parent/Guardian Mobile number of Parent/Guardian Date of Birth Permanent Address(Leave a blank between each unit of address House No. Street Name, PO, etc) Present Address (Leave a blank between each unit of address House No. Street Name, PO, etc) Gender Category Self/Family Income (p.a.) Religion Blood Group
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 Duly filled up SMS OPT in 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 ŀ Fees can be paid by cash/demand Draft/Pay Order. ŀ 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.] ŀ Demand Draft/Pay Order for Course Fees to be prepared in favour of St. Xavier s 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]
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 July 2015 - June 2016 Name of Parent/Guardian Permanent Address (Leave a blank between each unit of address House No. Street Name, PO, etc) Date of Birth Blood Group
STUDENT S COPY INSTITUTION S COPY BANK S COPY
St. Xavier s College (Autonomous) Career Oriented Programme 30, Mother Teresa Sarani (Park Street), Kolkata 700 016 Phone: +91 33 2255 1288/89, e-mail: career@sxccal.edu SMS OPT-IN APPLICATION July 2015 - June 2016 Permanent Address(Leave a blank between each unit of address House No. Street Name, PO, etc) Declaration: I hereby agree to subscribe to SMS services. I have no objection to St. Xavier s College, Kolkata sending SMS alerts other information. I understand that the SMS Alert Service will be sent to my Mobile No. as shown above and in case of any change in my Mobile No., I shall forthwith intimate the College Registry so as to enable the Registry to send the SMS Alerts on the new Mobile No. I understand that, St. Xavier s College will not be responsible for discrepancy/inaccuracy, if any, in the SMS Alert Services due to technical or any other unforeseeable reasons. DATE: PLACE SIGNATURE