22-02-2022 23:07:43

Department of Health & Family Welfare

West Bengal Counselling for NEET UG
2021
Re- enrollment request slip
Applicant's
Roll No.: 4608120191 DIA BANERJEE
Name:
P e rsonal Data
Caste /Re se rvation
Date of Birth: 05-06-2002 UR
Status:
All India NEET-UG
2021
Rank : 140963 P C Status : NO

Mobile No : 8777413079 Dom ic ile State : We st Be ngal

Online P aym e nt
NEET UG Applic ation No.: 210410371803 WSM20882653906
Transac tion No. :
Whe the r c andidate has passe d in 10+2
e xam ination in P hysic s, Che m istry and
Biology
and English individually (UR/EWS
c andidate s m ust have obtaine d 50% NEET UG
m arks take n toge the r in
P hysic s, Ye s Obtaine d 90.837
Che m istry and Biology; URP C/EWSP C P e rc e ntile :
c andidate s 45% or above ; SC/ST/OBC-
A/OBC-B/SCP C/STP C/OBC-A
P C/OBC-B P C
c andidate s 40% or above )?

De c laration by the c andidate

I
DIA BANERJEE, Roll Num be r-
4608120191, Applic ation No- 210410371803, NEET UG 2021 rank-
140963, do he re by
unde rtake that I have m ade non m ala fide m istake in filling up of the e nrollm e nt online form while e nrolling in Round 1 of
WB UG 2021 c ounse lling in wbm c c .nic .in we bsite .

I also unde rtake that I have ne ithe r be e n adm itte d in any se at at pre se nt through NEET UG WB 2021 c ounse lling.

I he re by re que st to allow m e for re -e nrollm e nt knowing fully that m y e arlie r data fille d up during Round 1 e nrollm e nt phase
would be e rase d and I have to e nroll afre sh with fre sh fe e paym e nt and fre sh re gistration and c hoic e filling for Round 2 WB
UG 2021 c ounse lling.

I unde rstand that e arlie r paid fe e will not be re funde d to m e and I have no c laim in e arlie r fille d data during Round 1
e nrollm e nt phase of WB UG 2021 c ounse lling.

No furthe r provision shall be provide d for any furthe r re c tific ation re que st. This is one tim e provision and shall not be state d
for pre c e de nc e anywhe re .

Signature of Candidate with date Signature of pare nt/guardian with date as witne ss

Note :

The above m e ntione d data is showing as pe r c andidate 's c urre nt e nrollm e nt status.

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