P.O. MAYNAGURI, DIST. JALPAIGURI

PIN CODE – 735224

Sl.No. - MC/ Date of Issue .......……............

FOR OFFICE USE ONLY

……….....................

Date of Admission........................…………....... Official’s Signature & Date

To

The President

Maynaguri College Alumni Association

Sir,

I beg to apply for membership of Maynaguri College Alumni Association.  I promise to abide by the rules and

regulations of the College and University. I furnish below the requisite particulars which are true to the best of my knowledge and belief.

Date ........................ Full Signature of Candidate

1. Full Name of the Applicant (in Block Letter) …………………………………..…………………

2. Telephone No. (House) …………………………………………………….…………...…………

3. Mobile No. of the student ……………………………………………………….…………...……

4. E-mail ………………………………………………………………………..………………….....

5. Block …………………………………………………………………………………….………...

6. Date of Birth …………………………………………………………………….………………...

YEAR OF PASSING :

7. STATUS : (i) Male / Female ………………………………………………...……………………

8. Whether SC / ST / OBC …………………………………...……………………….……………...

(Enclose attested copies of Certificates)