Application no:

Indian Institute of Science Education and Research Kolkata 279790

APPLICATION FORM
M.Sc in Mathematics (Autumn 2023)
Your Application Number is 279790. Please quote this number in any further communications.
Please take a printout of this document and bring it along with you.

Name: Subhajit Mondal

Date of Birth: 18-10-2002
279790
Gender: Male 0 6

Marital Status: Single

Category: SC
Nationality: India
Blood Group: A+
Distinguishing Mark: A mole in cheek
Permanent Address: Chhatna Barabakra , Chhatna Barabakra
Bankura - 722132
WB, India
Father’s name: Ujjal Mondal
Guardian’s Name: Ujjal Mondal
Emergency Phone Number: 06297507954
Cell Phone Number: 07318738014
Email: subhajit1018@gmail.com

Educational Qualifications:
Name of Degree Board/University Name of Institution Year of Passing Percentage
10th WBBSE Chhatna chandidas vidyapith, 2018 72
chhatna
12th WBCHSE Chhatna chandidas vidyapith, 2020 89
chhatna
BSc Bankura University Bankura Sammilani college 2023 88

Qualifying Examination:
None

I, Subhajit Mondal, hereby declare that all the particulars furnished above are correct to the best of my knowledge and any change in the above informa-
tion 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 application
may be cancelled and the Institute may take any necessary action against me.

Date: April 26, 2023

(Signature of Candidate)
SUBHAJIT MONDAL