3/26/22, 1:14 PM Confirmation Slip

Surendranath College
"NAAC Re-Accredited"
24/2, Mahatma Gandhi Road, Kolkata: 700 009.
Phone No. : (033) 2350 2864, 2354 3876   
Email : principalsurendranathcollege@gmail.com     
Application for Admission to
Application No.: SNC21053448 Date : 27 September 2021
CHEMISTRY Honours (2021-22)
FOR OFFICE USE ONLY

Roll No.: ________________ SC N ST N OBC-A N OBC-B N PH N

Code : 2009     Combination : CEMA-MTMG-STSG-ENVS-BNGM

Checked & Verified Approved

Sd/- Sd/-

For Department Sign. of the Principal / Teacher-In-Charge

1. Name in full : KARTAYAN KARMAKAR
2. Date of Birth : 8/10/2002
3. Gender : Male 4. Marital Status : Unmarried
5. Nationality : INDIAN 6. Religion : HINDUISM
7. Category (General/SC/ST/OBC) : GENERAL 8. State of Domicile : WEST BENGAL
9. Physically Challenged : No 10. Blood Group :
11. Year of passing H.S/Equivalent : 2020 12. Mother Tongue : BENGALI
13. Willing to join : 14. Whether BPL ? : NO
15. Minority Group : NO 16. CU Registration No :
17. 1st Generation Learner : NO 18. Aadhaar No. :
19. Applied in Sports Quota? : NO

Generic Elective subject combination * : Mathematics (Sem 1) & Statistics

AECC - ENVS (compulsory) and : Bengali

20. Admitted in add on courses? : NO

21. Father's Name : KASHINATH KARMAKAR
22. Father's Academic Qualification : X AND BELOW 23. Father's Occupation : SERVICE
24. Mother's Name : MUKTI RANI KARMAKAR
25. Mother's Academic Qualification : NONE 26. Mother's Occupation : HOUSEWIFE
27. (a) Guardian's Name : KASHINATH KARMAKAR
  (b) Relationship : FATHER (c) Occupation of Guardian : SERVICE
28. Nearest Railway Station : SAHAPUR
29. No. of Family Member : 5 30. Annual Family Income : 60000
31. Address :
(i) Permanent Address
Address : SHAHAPUR TEOR HILI DINAJPUR
P.O. : TEOR P.S : HILI
City/Village : SHAHAPUR District : DINAJPUR
Locality Type : URBAN State : WEST BENGAL
Country : INDIA PIN Code : 700001
Contact No. : STD Code  91    Phone No  8013948079
  (ii) Local Address
Address : SHAHAPUR TEOR HILI DINAJPUR
P.O. : TEOR P.S. : HILI
City/Village : SHAHAPUR District : DINAJPUR
State : WEST BENGAL Country : INDIA
PIN Code : 700001
Contact No. : STD Code  91    Phone No  8013948079 Mobile No. : 8013948079
Email : KARTAYAN@GMAIL.COM

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3/26/22, 1:14 PM Confirmation Slip

Application for Admission to

Application No. : SNC21053448 Date : 27 September 2021
CHEMISTRY Honours (2021-22)

RESULT OF QUALIFYING EXAMINATION

Name : KARTAYAN KARMAKAR
Result declared by your Board : PASSED
Roll No. : 12647444    Year : 2020
Index No./Registration No. :     
Year :
Board : C.B.S.E
Institution Name : .
Institution Address : .
Medium of Instruction at 10+2 level : ENGLISH
Passed (10+2) or Higher Education from Non Formal Education System (Approved by Distance Council of India or UGC): NO
MARK SHEET

Full Marks Pass Marks Marks Obtained

Sl. No. Subject
Theory Practical Theory Practical Theory Practical
1. ENGLISH 100 0 33 0 82 0
2. CHEMISTRY 100 0 33 0 84 0
3. MATHEMATICS 100 0 33 0 64 0
4. PHYSICS 100 0 33 0 69 0
5. BIOLOGY 100 0 33 0 89 0
6. BENGALI 100 0 33 0 86 0
7. ENVS / EED / ES 0 0 0 0 0 0

Aggregate (of Top Four Subjects) : 85.25%      

Effective Aggregate : 341.00      
Merit Marks : 425.00

* Subject in which an applicant failed in the previous qualifying examination cannot be taken
either as Honours or Elective subject and University of Calcutta will not issue admit card against any such case.
I hereby declare that all entries made by me in this form are true.
If anything found not true, I understand that my candidature stands cancelled.

Declaration: I hereby declare that I undertake to abide by all the rules and regulation of the College and University (whichever is
applicable in my case) now in force or to be in force during the course of my study in this college. (ii) If I join NCC, I accept the
condition that I would not be promoted / sent-up for University examination unless I attended the requisite percentage of class and
parades arranged by the NCC directorate. (iii) If I fail to submit the Migration / Registration certificate within the stipulated period, I
would not request the authority to condone any decision as may be decided by him/her with regard to continuation of my
studentship In this college. (iv) Failure to attend 75% of classes in each subject or failure to secure pass marks in each subject in
Annual /Test examination, would debar me from being promoted to second year class or be sent-up for respective degree
examination as the case may be. (v) Agree to change any subject if advised by the office in case present selection of subjects is
found to be not in accordance with the University rules. (vi) My studentship will be liable to be cancelled if falsification is detected
in the statements made/documents submitted in any stage. Application will be cancelled if any mistake repugnant to rules is
detected irrespective of its origin.

Signature of the Candidate

Date : (Required at the time of admission)
1. Candidate must take the print out of pay-in-slip / challan (1 page) generated after successful online submission of the form and
produce the duly paid Applicant's copy at the time of admission.
2. Candidate must take the print out of Application Form (2 pages) generated after successful online submission of the form and
produce the same at the time of admission.
3. All original admit cards & mark sheet; two photocopies without attestation.
4. Two recent stamp size photographs.
5. Break of study Certificate for the applicant who did not take admission in the last academic session.
6. School leaving Certificate mentioned in the proforma.
7. Original and without attestation photocopies of cast certificate seeking reservation.
8. Original migration Certificate (in case of Other Board).
9. One original copy of Annual Income Certificate from the respective authority.

Sr. No. Application History

1 Submitted on 27-09-2021 at 11:27 pm

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