West Bengal Joint Entrance Examinations Board

e-Admission System for WBJEEM-2016

Confirmation Page

Application No.

6146625

DO NOT SEND THIS PAGE TO WBJEEB.

CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Details
Name:

ABHISHEK BHATTACHARYA

Date of Birth:

07-12-1996

Mother's Name:

SHELLEY BHATTACHARYA

Category:

General

Father's Name:

DEBASISH BHATTACHARYA

Person with Disability(PwD):

No

Gender:

Male

Nationality:

Indian

Have you applied in JEE(Main) - 2016 ? :

No

Place of Residence:

Municipality/Corporation

Home District:

KOLKATA

Religion :

Hindu

TFW :

Yes

Income Category :

Below 2.5 Lakhs

Domicile:

WEST BENGAL

Course Apply Details

Applying For:

Engineering

1st Choice of Exam Centre:

Kolkata - Behala

3rd Choice of Exam Centre:

Kolkata - Tollygunje

2nd Choice of Exam Centre:

Kolkata - Taratala

Educational Details
Qualification

Pass
Status

Course/Stream Name

Board/University Name

Year Of
Passing

Marks (%)

Roll No.

Institute Name, Address & Pincode

10th or
equivalent

Passed

10th

INDIAN COUNCIL OF
SECONDARY EDUCATION,
INDIA

2013

83.66

T/4720/066

Vivekananda Mission School,Vivek

Ville,Joka,Kolkata-700104

12th or
equivalent

Passed

(10+2)/I.Sc/Equivalent
examination passed

INDIAN SCHOOL
CERTIFICATE

2015

74

5519028

Vivekananda Mission School,Vivek

Ville,Joka,Kolkata-700104

Communication Details
Address:

GOVT HOUSING ESTATE,AJANTA QUATER,D.H

ROAD,BEHALA

City/Town/Village:

KOLKATA

District:

KOLKATA

State:

WEST BENGAL

Pin Code:

700038

Email Address:

abhishekbhatta96@gmail.com

Mobile Number:

9038340641

Land Line Number:

9038340641

Fee Payment Details

Payment Mode:

Using eChallan of Allahabad bank

Transaction ID:

30331

Exam Fee:

500 /-

Date of Transaction:

2/24/2016 12:00:00 AM

Fee Submitted On:

24/02/2016
DECLARATION

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read and understood the WBJEEM-2016
procedures. I shall abide by the terms and conditions thereon.

Images Uploaded by Candidate

Photograph

Signature

Thumb Impression