Admission Form

1. PERSONAL DETAILS
Name (Please give full name in English – BLOCK CAPITAL as per SSC Memo)
Name of the Father :
Profession / Occupation :
Name of the Mother :
Date of Birth :
Sex :
Nationality (on Passport):
Passport / Citizenship No:Date of Issue:
Place of Issue: Date of Expiry:

2. ADDRESS FOR CORRESPONDENCE3. PERMANENT ADDRESS
Post Code : Post Code :
Phone : Phone :
Email Address :Email Address :

4. DETAILS OF QUALIFYING EXAMINATION
S. No.ClassYear of Passing% Marks/GradingBoard of ExaminationName of the Institution
1.10th Std/SLC/‘O’ Level
2.12th Std/HSC/+2/ ‘A’ Level
3.Degree
4.Others

5.DESIRED COURSE AT GNI (Please select the course with a  mark)
UNDER GRADUATE Post Graduate Courses
Enclosed Copies (Please put a  mark against the documents which enclosed points 1 to 7)
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2
3
4
5
6
7
At the time of submission of Original Certificates as mentioned above, the following docuents
also to be submitted for ratification from Affiliating University / State Government.
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9
10
11
12
13

6. DECLARATION (Student) / (Parent)

Place : Date :
Signature : Signature of the Father/ Guardian
7. FOR OFFICE USE ONLY
Date : In-Charge Admissions : Director :