SI-UK STUDENT INFORMATION SHEET

By completing this form, I give permission to SI-UK to enter my information into application
forms for the courses and schools listed under University Choice.

Personal Details

First Name: ARYAMAN Family Name: CHAKRABORTY

Gender: MALE Date of Birth: 18/09/2000
Nationality: INDIAN Country of Birth: INDIA
Email: aryamanchakraborty141@gmail.com Phone Number: 7003447143
Passport No. : U9237509 PP start Date : 01/02/2021 PP end Date : 31/01/2021
Permanent home address (in English):

14, Rajkrishna Pal lane, Garfa, Kolkata 700075

UK address including post code (if available):

Immigration Details (for student who has studied in UK before || Leave blank if not applicable)

Date of first entry to the UK:

Date of most recent entry to the UK:
Do you need a visa to stay in the UK?
If the answer is yes,
1. What is your visa status?
2. When is your current visa expiry?
3. Have you ever been refused a visa to the UK?

Education Background

Dates of study Name of Course Title Level of study, Final/ Predicted

Institution and (eg.NQF Level, Result
Country High School,
Bachelor, Master)

Start date: (MM/YY) St. Lawrence High NA Secondary 90%

End date: School School
Start date: Delhi Public Science stream Higher 75%
End date: School , Ruby Secondary
Park School
Start date: Heritage Institute Electronics and Bachelor 8.5/10 CGPA
End date: of Technology communication
engineering

Work/Internship experience (if available)

Job Title:
Name of organisation:
Address of organisation:
Dates: From (MM/YY) To (MM/YY)
Duties:

1
References (One for UG, two for PG):

Reference 1
Title: (Mr./Ms./Mrs./Dr.) Mrs Position: Assistant Professor
Name: Moulipriya Sarkar Phone number:
Work email: moulipriya.sarkar@heritageit.edu
Relationship to you: Professor
How long has the person known you? 4 years
Name of Institution/Organisation: Heritage Institute of Technology, Kolkata
Address of Institution: Chowbaga Rd, Anandapur, Mundapara, Kolkata, West Bengal 700107

References 2
Title: (Mr./Ms./Mrs./Dr.)Dr Position:Head of the Department (ECE)
Name:Prabir Banerjee Phone number:
Work email: prabir.banerjee@heritageit.edu
Relationship to you: professor
How long has the person known you?4 years
Name of Institution/Organisation: Heritage Institute of Technology,Kolkata
Address of Institution: Chowbaga Rd, Anandapur, Mundapara, Kolkata, West Bengal 700107

Do you have a disability?

No Yes (please state)

Do you have any criminal convictions?

No Yes (please state)