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APPLICATION FORM :

PERSONAL INFORMATION

APPLICATION NO. : 209385

FULL NAME: ANTARIKSHA BASU

DATE OF BIRTH: 05-09-2002

MOBILE NUMBER: 9883687290

ALTERNATE MOBILE NUMBER: 9883687290

EMAIL ID: BOSENEIGEN@GMAIL.COM

COURSE APPLIED FOR: INTEGRATED PHD

JEST DISCIPLINE: PHYSICS

GENDER: MALE

RESERVATION CATEGORY: UNRESERVED

FEES AMOUNT: 800.00

EXAM CITY: EXAM CITY PREFERENCE 1 CHANDIGARH

EXAM CITY PREFERENCE 2 AMRITSAR
EXAM CITY PREFERENCE 3 DELHI

PERSON WITH DISABILITY (PWD) NO

CURRENT ADDRESS: ADDRESS: ASHUTOSH MUKHERJEE ROAD, COLLEGE PARA

STATE/U.T.: WEST BENGAL (WB)
CITY: SILIGURI
PINCODE: 734001

PERMANENT ADDRESS: ADDRESS: ASHUTOSH MUKHERJEE ROAD, COLLEGE PARA

STATE/U.T.: WEST BENGAL (WB)
CITY: SILIGURI
PINCODE: 734001

EDUCATION DETAILS

EXAMINATION NAME OF PASSING BOARD/UNIVERSITY/ CGPA/GRADE MAXIMUM MARKS PERCENTAGE

THE YEAR INSTITUTE MARKS OBTAINED
SCHOOL/
COLLEGE/
INSTITUTION
 *10TH / DELHI 2018 CBSE 500 413 82.60
MATRIC / PUBLIC
EQUIVALENT SCHOOL
SILIGURI

*12TH / DELHI 2020 CBSE 500 438 87.60

INTERMEDIATE/ PUBLIC
EQUIVALENT SCHOOL
SILIGURI

*GRADUATION APCRGC 2023 NORTH BENGAL 8.07

BSC. PHYSICS UNIVERSITY
HONS

MAJOR
SUBJECT:
PHYSICS

UPLOADED DOCUMENTS:

PAYMENT

BANK REFERENCE
STATUS FEE DETAILS NO. TRANSACTION DATE PAYMENT MODE

SUCCESSFUL 800 JEST2024-OL126803 23-01-2024 ONLINE

DECLARATION:

I CONFIRM THAT THE INFORMATION GIVEN IN THIS FORM IS TRUE, COMPLETE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE AND BELIEF AND IN CASE OF ANY OF THE ABOVE INFORMATION IS FOUND TO BE FALSE OR UNTRUE
OR MISLEADING OR MISREPRESENTING, IT MAY LEAD TO THE CANCELLATION OF MY CANDIDATURE AND
ORGANIZING INSTITUTE CAN TAKE LEGAL ACTION AGAINST ME.

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