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    Sibsagar College

    Uploaded by

    dhurbagogoi722

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Sibsagar College

    Uploaded by

    dhurbagogoi722
    38 views2 pages

    Original Title

    SIBSAGAR COLLEGE

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    38 views2 pages

    Sibsagar College

    Uploaded by

    dhurbagogoi722

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Assam State Higher Education Admission Portal

    Admission Session 2024-2025


    Registration Number: 240002558
    Form Number: 84107432

    Programme : Bachelor of Science(Faculty of Science)


    College : 99: Sibsagar College (Autonomous)
    University: 991: Sibsagar College - Autonomous
    Application Status : Submitted
    Admission Scheme: 1 Major 1 Minor
    Course(s) Selected:
    Subject I: Zoology
    Subject II: Botany
    Personal Details
    Full Name of the Applicant : DHURBA GOGOI Gender : Male
    Date of Birth: 17 November 2006
    Social Category : OBC / MOBC(Undertaking)
    Age as on: July 1, 2023: 16 Years 7 Month 15 Days
    Blood Group: O+ Religion : Hinduism
    Nationality Indian
    Do you have domicile of Assam? Yes
    Registered Email : dhurbagogoi722@gmail.com Registered Mobile Number: 8011947979
    Alternate Email : Not Provided Alternate Mobile : Not Provided
    Correspondence Address : Gelakey kolia pani gaon,
    Permanent Address: Gelakey kolia pani gaon, Gelakey kolia pani gaon ,
    Gelakey kolia pani gaon , SIVASAGAR, Assam -785696,
    SIVASAGAR, Assam -785696, India
    India
    ID Proof : Other Valid Govt Identity with photograph ID Proof No : 590358518984

    University Registration details (if applicable)


    Have you enrolled in University/Autonomous College before? : No Registration Number: Not Provided
    University Name of School/Department/Faculty/College: Not Provided Programme registered in: Not Provided
    Family Details
    Mother's Name : Biju gogoi Father's Name : Mohendra gogoi
    Mother's Qualification : None Father's Qualification : Graduation
    Mother's Occupation : Un Employed Father's Occupation : Retired
    Mother's Mobile Number : 7635865031 Father Mobile Number : Not Provided
    Mother's Office Address : Not Provided Father's Office Address : Not Provided
    Guardian's Name : Not Provided
    Relation With Guardian's : Not Provided
    Guardian's Occupation : Not Provided
    Father your Guardian : No
    Guardian's Qualification : Not Provided
    Guardian's Office Address : Not Provided
    Guardian's Mobile No : Not Provided
    Emergency Contact Number : 8011323524
    Combined Family Income : Up to 2,00,000
    Other Category/Quota
    Person with Benchmark Disabilities (PwBD) Category : Not Applicable
    Are you an Ex-Service man? : No
    Are you dependent of Freedom Fighter? : No
    Sports Quota No
    Do you have any illness which requires continuous or emergency medical attention? No
    Do you belong Urban/Rural/Semi-Urban/Metropolitan Area? Rural
    Are you Son/Daughter of present employee of university/college ? No
    Do you belong to Fringe Village of Assam? No
    Do you belong to Moran Community of Assam? No
    Do you have Migration Certificate? No
    Do you have transfer certificate from your School/College? No
    a) Candidates having NCC 'B' 'C' certificate No
    b) Have you attended any special camp under the National Service Scheme No
    Language Proficiency (Reading/Writing/Speaking)
    Hindi Reading Writing Speaking
    English Reading Writing
    Assamese Reading Writing Speaking
    Qualification Details - X or Equivalent
    Class X Year of Passing 2022
    Class X Percentage (If your mark is in CGPA, please convert to equivalent
    7.40
    percentage as per your CGPA score and CGPA Scale)
    Class X Name of the Institution/School Godapani high school
    SECONDARY EDUCATION BOARD of ASSAM
    Class X Board/University
    (SEBA)
    Assamese, English, maths, science, social science,
    X Subject Combination
    geography
    Class X Division First Division
    Qualification Details - XII or Equivalent
    Class XII Qualification Status Passed
    XII Year of Passing Final Examination 2024
    Class XII Stream Science
    Class XII Percentage 57.17
    Class XII Division First Division
    Class XII Name of the Institution/School Nazira h.s. and m.p. school
    Class XII Board/University ASSAM HIGHER SECONDARY EDUCATION COUNCIL
    Class XII Subject Combination Assamese, English, chemistry, physics, biology, maths
    Class XII Roll Number 0871 20008
    XII Score Card
    Name of the Subject Total Marks Obtained Marks
    ASSAMESE 100.00 56.00
    ENGLISH 100.00 57.00
    BIOLOGY 100.00 64.00
    PHYSICS 100.00 70.00
    MATHEMATICS 100.00 32.00
    CHEMISTRY 100.00 64.00

    Uploads
    Document Upload Status
    Photo Uploaded
    Signature Uploaded
    OBC Category Certificate Undertaking Uploaded
    ID Proof Document Uploaded
    Proof of permanent residence of Assam (PRC, Voter ID, Aadhar, Caste Certificate, Birth Certificate, School ID, or any
    Uploaded
    other certificate issue by competent authority of Govt of Assam)
    Income Certificate [Certificate issued by the Circle officer(Competent Reveneue Authority) only will be valid.] Uploaded
    Class X (Scan your marksheet in a single file and upload)] Uploaded
    Class XII (Scan your marksheet in a single file and upload) Uploaded
    "I do hereby declare that all the statement made in the application are true, complete and correct to the best of my knowledge and belief. I am duly
    aware that in the event of any particulars or information furnished by me is found to be false/incorrect/incomplete or if i am found indulging in some
    unlawful act at any time during the course period, my candidature is liable to be summarily rejected/cancelled."Additionally undertaking for students
    whose results are awaited: "I, having been permitted to be provisionally admitted to University hereby undertake to produce the proof of having
    successfully qualified in the final qualifying examination with requisite percentage of marks if failing, I shall forthwith vacate the seat and shall have no
    claim for refund of fees already paid."

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