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Bagbazar Howrah Durgapur Agartala
78, Bagbazar Street (Beside Girish Mancha),
Kolkata - 700003
54/4, Andul Road, Howrah - 711109.
Debendra Bhaban, Nachan Road, Benachity,
Durgapur - 713213
Baibav Bhavan, Gurkhabasti, VIP Road, Opposite Maya Honda Showroom,
Near Nehru Park, Beside Bijaya Bank, Agartala.
Name of the Branch (admission sought for): ________________________________
1. Tick mark the COURSE desired for admission:
Jyotish Ratna Jyotish Bidyabhusan Jyotish Bidyabisharad
Jyotish Martanda Ph.D (Honorary)
2. Name of the Candidate (IN BLOCK LETTERS) Mr./Ms./Mrs.:
________________________________________________________________________
3. Name of father/husband: ___________________________________________________
4. Address for communication with address proof:
_______________________________________________________________________________________________
5. Contact No.: Mobile: _______________________________ Land line: __________________________________
Email Id: ______________________________________________________________________________________
6. Academic qualification: __________________________________________________________________________
7. Age with proof: ________________________________________________________________________________
8. Mother Tongue: ________________________________________________________________________________
9. Tick mark the language(s) you can write: Bengali Hindi English
10. Tick mark medium of instruction you prefer: Bengali Hindi English
11. Any education/ knowledge/ experience in Astrology already acquired:
______________________________________________________________________________________________
12. Extra Curricular Activities:
______________________________________________________________________________________________
I hereby undertake to abide by the rules and regulations of the institute, promise to pay due respect to the teachers
and extend all kinds of cooperation.
Date:
Place:
Past your
photo here
Signature of the Candidate