RECEIPT COPY OF ONLINE APPLICATION

CALCUTTA UNIVERSITY
UNIVERSITY OF CALCUTTA , 87/1, COLLEGE STREET , KOLKATA , 700073

Application Form
Academic Session: 2021-22

APPLICATION / FORM NO: 2021090476934

Application / Form No 2021090476934 Course Name M.SC/B.Tech

No of Group(s) 2 Group(s) 219 (ATSC), 206 (PM)
Amount Fee Waived Type CU

SELECTED SUBJECT(S) WITH INSTITUTES AND ORDER OF PREFERENCE

1. 219 (ATSCCU), 9. 206 (PMBL), 11. 206 (PMCU), 2. 206 (AMND), 10. 206 (PMBT), 8. 206 (PMBE), 15. 206 (PMUL), 4. 206 (CSECU), 13.
206 (PMLB), 12. 206 (PMFC), 7. 206 (ITCU)

PERSONAL DETAILS

Applicant Name CHANCHAL GHOSH Date of birth 20-03-1996

Mother's Name MONIKA GHOSH Father's Name SUNIL GHOSH
Mother's Occupation HOME MAKER Father's Occupation AGRICULTURE
Alternate Mobile
Mobile Number 7908765131
Number
Email Id ghosh.chanchal777@gmail.com GenderMALE
Category OTHER BACKWORD CLASS-B Nationality
INDIAN
Religion HINDUISM Aadhar No.
Marital Status UNMARRIED Empl Status
UNEMPLOYED
Locality RURAL PWD NO
Family Income 72000.00 Blood Group
B+
Sports Quota NO
Permanent Address VILL- NEGUN, PO - NEGUN, PS- MONGALKOTE,PURBA BARDHAMAN, INDIA, WEST BENGAL, 713143
Present Address VILL- NEGUN, PO - NEGUN, PS- MONGALKOTE,PURBA BARDHAMAN, INDIA, WEST BENGAL, 713143

ACADEMIC QUALIFICATIONS

Div./Class Obtained Full Percentage Year of College/School Board/University

Sl Examination Passed Status CGPA
awarded Marks Marks of Marks Passing Name Name
JABAGRAM.M.K
1. SECONDARY PASSED FIRST NO 558.00 700.00 79.71 2012 WBBSE
INSTITUTION
BURDWAN SRI
RAMKRISHNA
HIGHER
2. PASSED FIRST NO 304.00 500.00 60.80 2015 SARADAPITH WBCHSE
SECONDARY/INTERMEDIATE
UCHCHA
VIDYALAYA
SURENDRANATH
3. B.A/B.SC/B.COM PASSED FIRST NO 499.00 800.00 62.38 2021 CU
COLLEGE

HS(10+2)/INTERMEDIATE MARKS DETAILS

# Subject 1 Subject 2 Subject 3 Subject 4 Subject 5 Subject 6

Name ENGLISH BENGALI CHEMISTRY MATHEMATICS BIOLOGY NONE
Theory
52 70 45 60 39 0
Marks
Practical
19 19 0
Marks
Full
100 100 100 100 100 0
Marks
 RECEIPT COPY OF ONLINE APPLICATION

CALCUTTA UNIVERSITY
UNIVERSITY OF CALCUTTA , 87/1, COLLEGE STREET , KOLKATA , 700073

Application Form
Academic Session: 2021-22

APPLICATION / FORM NO: 2021090476934

UG MARKS DETAILS(1+1+1 MARKS DETAILS)

# Hons Subject Gen Subject(1) Gen Subject(2)

NAME MATHEMATICS CHEMISTRY PHYSICS
Marks
499 201 163
Obtained
Full Marks 800 300 300
Percentage 62.38 67 54.33

I , CHANCHAL GHOSH, hereby declare that all the particulars stated by me in this Application Form are true to the best of my knowledge and belief. I have read the relevant
Information Brochure & Admission Schedule pasted on the University website / Printed Hard Copy / Notice Board for admission . I shall abide by the terms and conditions therein. It is
entirely my responsibility to prove my eligibility for admission to the Programme to which I am admitted and also in respect of qualifications and entitlement for admission against
reserved category, if claimed, to the satisfaction of the University . Further , in the event of suppression or distortion of any fact like category , educational qualifications, nationality,
etc. made in my Application Form , I understand that my admission, if granted or degree acquired subsequently , is liable for cancellation. I also understand that the decision of
University of Calcutta regarding my admission will be final and I shall abide by the rules and Regulation of University of Calcutta from time to time.
ENCLOSURES
(i) Copy of Admission Receipt
(ii) Self Attested true copies of marks-sheets of all the examinations passed
( 10th Standard onwards.)
(iii) Proof of Date of Birth Certificate.
(iv) SC/ ST / PWD / OBC-A / OBC-B/ Domicile Certificate, if applicable.
(v) Copy of aadhaar card.

Application Date : 12-09-2021 Signature :

Signature with Date