Surendranath College Challan

SURENDRANATH COLLEGE"NAAC Accredited B++"

24/2, Mahatma Gandhi Road, Kolkata: 700 009.

Phone : (033) 2350 2864, 2354 3876. Fax : (033) 2350 2864.

Application for Admission to Microbiology Honours (2015-16)

FOR OFFICE USE ONLY

Roll No.:________________ SC N ST N OBC-A N OBC-B N PH N

Code : 31101 Combination : MCBA-CEMG-PHSG-ENGC-HINM

Checked & Verified

Sd/-

For Department

Approved

Sd/-

Sign. of the Principal

Application No.: 28789 Date : 05 June 2015

1. Name in full: CHIRANTAN BANERJEE

2. Date of Birth 28/6/1997 Gender: Male

3. Marital Status: Unmarried

4. Category (General/SC/ST): General

State of Domicile: West Bengal

5. Nationality: INDIAN

6. Religion: HINDU

7. Physically Challenged (PC): No

8. Blood Group: B+

9. Year of passing H.S/Equivalent: 2015

Elective Subject Combination Language Group

Chemistry & Physics, English (compulsory) and Hindi

10. Father's / Mother's Name: SURAJIT BANERJEE

11. Occupation: SERVICE

12. Local Address: 29/7 BALLYGUNGE PARK FLAT NO. C-6 KOLKATA-700019

Phone No.: STD: 033 No.: 22871313

13. Mobile No: 9433421304

14. Police Station: KAREYA

15. Nearest Railway Station: PARK CIRCUS

16. Annual Family Income: 1200000 No of Family Member: 3

17. CU Registration No. (If Any):

Page 1 of 5Confirmation Slip

6/5/2015http://www.sncadmissions.com/ApplyUG2015/PrintApplication.asp

18. Result declared by your Board: Passed



RESULT OF QUALIFYING EXAMINATION

Name: CHIRANTAN BANERJEE Roll: 400611 No.: 1717 Year: 2015

Board: W.B.C.H.S.E

Institution Name: PATHA BHAVANInstitution Address: 8/2 GARIAHAT ROAD KOLKATA-700019

MARK SHEET

Sr. SubjectFull Marks Pass Marks Marks Obtained Aggregate%

(Best Four Subjects)Theory Practical Theory Practical Theory Practical

1. ENGLISH 80 20 24 6 70 18 82.25%

Effective Aggregate

82.25%

Merit Marks

416.00

2. HINDI 80 20 24 6 53 18

3. BIOLOGY 70 30 21 9 59 28

4. MATHEMATICS 80 20 24 6 32 18

5. CHEMISTRY 70 30 21 9 36 29

6. PHYSICS 70 30 21 9 55 28

7. ENVS / EED / ES 0 0

I hereby declare that all entries made by me in this form are true.

If anything found not true, I understand that my candidature stands cancelled.

Declaration I hereby declare that I undertake to abide by all the rules and regulation of the College and University (whichever is

applicable in my case) now in force or to be in force during the course of my study in this college. (ii) If I join NCC, I accept the

condition that I would not be promoted / sent-up for University examination unless I attended the requisite percentage of class and

parades arranged by the NCC directorate. (iii) If I fail to submit the Migration / Registration certificate within the stipulated period, I

would not request the authority to condone any decision as may be decided by him/her with regard to continuation of my studentship

In this college. (iv) Failure to attend 75% of classes in each subject or failure to secure pass marks in each subject in Annual /Test

examination, would debar me from being promoted to second year class or be sent-up for respective degree examination as the case

may be. (v) Agree to change any subject if advised by the office in case present selection of subjects is found to be not in accordance

with the University rules. (vi) My studentship will be liable to be cancelled if falsification is detected in the statements

made/documents submitted in any stage. Application will be cancelled if any mistake repugnant to rules is detected irrespective of its

origin.

Signature of the Father/ Mother with date Signature of the Candidate with date

(Required at the time of admission)

DOCUMENTS TO BE PRODUCED AT THE TIME OF ADMISSION

1. Candidate must take the print out of pay-in-slip / challan (1 page) generated after successful online submission of the

form and produce the duly paid Applicant's copy at the time of admission.

2. Candidate must take the print out of Application Form (2 pages) generated after successful online submission of the

form and produce the same at the time of admission.

3. All original admit cards & mark sheet; two photocopies without attestation

4. Two recent stamp size photographs.

5. Break of study Certificate for the applicant who did not take admission in the last academic session.

6. School leaving Certificate mentioned in the proforma.

7. Original and without attestation photocopies of cast certificate seeking reservation.

8. Original migration Certificate (in case of Other Board).

9. One original copy of Annual Income Certificate from the respective authority.



PAY IN SLIP

IDBI BANK

DATE : 05 June 2015 BANK COPY

Surendranath CollegeA/c. No. : 1398102000001137

IDBI BANK BRANCH :

Application No. : 28789 Honours : Microbiology

Name : CHIRANTAN BANERJEE

AMOUNT : Rs. 200/- (Rupees Two Hundred Only)Received Rs. 200/- as application fees for admission to the 1st year Class at Surendranath College, Kolkata

Depositor's Signature Signature with seal of Receiving Authority

IDBI BANK

DATE : 05 June 2015 COLLEGE COPY

Surendranath College A/c. No. : 1398102000001137

IDBI BANK BRANCH :



AMOUNT : Rs. 200/- (Rupees Two Hundred Only) Received Rs. 200/- as application fees for admission to the 1st year Class at Surendranath College , Kolkata


IDBI BANK

DATE : 05 June 2015 APPLICANT COPY

Surendranath College A/c. No. : 1398102000001137

IDBI BANK BRANCH :



AMOUNT : Rs. 200/- (Rupees Two Hundred Only) Received Rs. 200/- as application fees for admission to the 1st year Class at Surendranath College , Kolkata




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Surendranath College Challan