Registration Slip No:

Indian Institute of Science Education and Research Kolkata 511262

5 Year BS-MS Dual Degree Programme

REGISTRATION SLIP (SPRING 2018)
Your Registration Slip Number is 511262. Please quote this number in any further communications. Please take a printout of this document and bring it along
with you.
Name: Akash Kumar Nigam
Roll No: 16MS147
Date of Birth: 27-10-1997
Gender: Male 0 511262 7

Marital Status: Single

Category: SC
Admitted Under: SC
Nationality: Indian
Aadhaar No.: None
Blood Group: AB+
Distinguishing Mark: Mole on lower lip
Permanent Address: VILL - NADAH, P.O. - DUMARBHAR
PADRAUNA - 274304
Father's name: Uttar Pradesh, India
Vinod Kumar Nigam
Emergency Phone Number: 09752416776
Cell Phone Number: 07869916020
Email: akn16ms147@iiserkol.ac.in

Educational qualifications:

Name of Examination Board/University Name of Institution Year of Passing Percentage

10th CBSE Kendriya Vidyalaya No.2 CPE 2013 91.2
12th CBSE Itarsi 2015 60.8
Vidya Mandir Sr.Sec School
Kota

Payment details:
Registration Fee: Rs 9550/-, Transaction No: 1177586247, Bank Transfer from PUNJAB NATIONAL BANK,ITARSI on 21-12-2017

I, Akash Kumar Nigam, hereby declare that all the particulars furnished above are correct to the best of my knowledge and any change in the above in-
formation in future will be immediately intimated to the Institute. I understand that if at any point of time, any of the information is found to be false, my
registration may be cancelled and the Institute may take any necessary action against me.

I also undertake to abide by the rules governing the conduct and maintenance of discipline for students in this Institute.

Date: December 21, 2017

(Signature of candidate)
AKASH KUMAR NIGAM