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AMIK INSTITUTE OF MANAGMENT
SCIENCES AND TECHNOLOGY

3 & 4 Kabiguru Sarani, City Centre, Durgapur - 713216
Tel : (0343)2569890, 7384885508, e-mail : amikdurgapur@rediffmail.com
Website : www.amikinstitute.org

APPLICATION FORM FOR BSW(H)/MSW

Serial No. AMIK2020000005

To
The Director
AMIK INSTITUTE OF MANAGMENT SCIENCES AND TECHNOLOGY
City centre, Durgapur - 713216, Burdwan, West Bengal

This form duly filled in, with documents wherever necessary,

should be submitted on or before............................................
*Incomplete forms will not be entertained

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Sir/Madam,

I hereby apply for admission in BSW(H)/MSW at AMIK for the session 2020 to 2021

.

Date : 07/08/2020

1. Course

:

2. Name(in block letters)

:

3. Father's Name/Guardian's Name/Husband's Name

:

4. Gender

:

5. Date of Birth (enclose supporting document)

:

6. Nationality

:

7. Present Address (mailing address)

:
:
:
:
:

8. Whether SC/ST/Physically Handicapped

:

(attach attested copy of certificates)

9. Statement of marks obtained at different examinations (Attach attested copies of mark sheets)

Name of the Examinaiton Board/Council/University Year of Passing Subjects Div./Class/Grade Percentage of Marks Total Marks of Obtained
S.F./Madhyamik/Equivalent
H.S. or Equivalent
B.A/B.Com/BSW

10. Any other Information

:

11. Name of the Insttution Last Attended

:

12. Registration No. of the Board

:

Council/University lasr attended

DECLARATION BY STUDENT

I do hereby declare that information provided in this form is true to the best of knowledge and belief.

Date: 07/08/2020

Place:

Full Signature of the Applicant