0480 2709093, 94, 83
ncas@nirmalacollege.in

application for admission to Under Graduate Courses 2016-2017

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Second Choice
Third Choice



1. Name of the candidate as in qualifying certificate *
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2. Date of Birth*
3. Age*
3. Sex * Male Female
5. Religion*
6. Caste*
7. Category
8. Nationality*
9. Place of birth*
10. Blood Group
11.Mobile no
12. Email*
13. Permanent Address *
Pin*
14. Telephone
15. Address for communication *
Pin
Telephone (with STD)
16. Father's Name*
Occupation
Mobile No.
Email
17. Mother's Name*
Occupation
Mobile No.
Email
18. Guardian's Name
Address
Email
Mobile No.
19. ACADEMIC QUALIFICATION*
Board Reg.No Year of Passing Grade % of Mark School No of Chances Regular/Open
10th
20. Details of mark Secured in the plus two examination *
Board Reg.No Year of Passing School Place No of Chances Regular/Open
Plus two
Subject Marks Obtained Grade Maximum Mark Percentage
Part I English
Part II Language
Part III Div.(Options)
Total
21. Centralized allotment details(if applicable only)
Allotment No. Allotment Date
Rank No. Category
22.    CAP ID Security Code
23. Other qualification if any
Course Institution Place Duration Grade/Mark
24. CO-CURRICULAR ACTIVITIES
Participation in Sports & Games
Item
Level
Achievement
Participation in Arts & Cultural activities :
Item
Level
Achievement
NCC/NSS/
Literacy Mission
Social Welfare Work
Other Extra curricular activities, if any
25. Annual Family Income*
26. Preffered Second Language *
27. Requirement of hostel facility
28. If any relatives working/ studying or worked /studied in this Group of Institution
Declaration

    I do hereby declare that the information mentioned in the application are true and correct. I do promise to comply with all the rules and regulations of the college and the directions of the college authorities from time to time and to help in maintenance of discipline in the college while I am a student of this college.







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