:: West Bengal SC ST & OBC Development and Finance Corporation ::

Particulars of Student

Applicant's Name ^*

Date of Birth^*

Gender^*

Caste^*

AADHAAR Number^*

Email^*

Applicant's Mobile No. ^*

Guardian's Mobile No. ^*

Name of present Institution^*

Present Class^*

Premises No. (Correspondence Address)

Locality/Road (Correspondence Address)^*

Village/Ward (Correspondence Address)^*

Town/City (Correspondence Address)^*

District ^*

Block ^*

Police Station (Correspondence Address)^*

Post Office (Correspondence Address)^*

Pincode^*

State

West Bengal

Country

India

Correspondence Address and Permanent Address are same

Premises No. (Permanent Address)

Locality/Road (Permanent Address)^*

Village/Ward (Permanent Address)^*

Town/City (Permanent Address)^*

District ^*

Block ^*

Police Station (Permanent Address)^*

Post Office (Permanent Address)^*

Pincode^*

State

West Bengal

Country

India

Choice of Centre(District) ^*

Preferred Location ^*

Enroll for Training ^* JEE NEET

Medium of Training ^* English Bengali

	Exam Name	Year	Marks	% of Marks	Name of Institution
X

Paticulars of Parents/Guardians

Father's Name^*

Father's Occupation^*

Mother's Name^*

Mother's Occupation^*

Guardian's Name^*

Guardian's Occupation^*

Business/Office Name

Business/Office Address

Annual Family Income^*

Bank Details

Account Number^*

Bank Name^*

Branch Name^*

IFSC code^*

Student Documents

ATTACH PASSPORT SIZE COLOR PHOTO^*[Image should be JPEG/JPG/PNG within 1MB Size.]

ATTACH COPY OF X STANDARD MARKSHEET^*[Document should be PDF within 1MB Size.]

ATTACH CASTE CERTIFICATE^*[Document should be PDF within 1MB Size.]

ATTACH FAMILY INCOME DECLARATION^*[Document should be PDF within 1MB Size.]

ATTACH BANK DOCUMENT^*[Document should be PDF within 1MB Size.]

Declaration

Security Code ^*

I do solemnly declare that all the particulars given above are true. I shall abide by the guidelines of the Backward Classes Welfare and Tribal Development Department, Government of West Bengal.