UNIVERSITY OF CALCUTTA

87/1, College Street, Kolkata - 700073, West Bengal, India

Application Form for Under Graduate Examinations

Date - 19/03/2019
Application Id. - 16060890
Examination - B.Sc. (Honours) PART-II Examination - 2019
(Under 1+1+1 2009 Regulation)

To
The Controller of Examinations
University of Calcutta
Sir,
I request permission to persent myself at the ensuing examination for which I deposit fees and furnish the required
particulars as follows:

Name - KARTIK BARIK

Father's/ Guardian's Name - TAPAN BARIK

Regsitration Number - 513-1121-0387-15 Roll No- 3513-41-0108

DOB - 05-02-1998
Gender - MALE

College - Code - Name - (513) SAMMILANI MAHAVIDYALAYA

Mobile No. - 9038671322 E-mail - barikkartik98@gmail.com

Communication Address - North Haradhanpur, Haradhanpur, Sagar, South 24 Parganas, PIN - 743373

Paper/Subject(s) to appear & Fees to be deposited:

Srl. No. Paper/Subject Code Paper/Subject Name Appear Type Lab Fees (Rs.)
1 CEMA CHEMISTRY (HONOURS) 290.00
2 MTMG MATHEMATICS (GENERAL)
3 PHSG PHYSICS (GENERAL) 120.00

Examination & other Fees 355.00

Total Fees to be deposited by the candidate to the College 765.00

I declare that if any of the statement made in the above be found to be not true or if it appears that, in the opinion of the University, I have
contravened the provisions of the University Rules and Regulations relating to the examination to which I now seek admission, my
candidature for the examination shall be liable to be cancelled by the University.

Date: Full Signature of the applicant with Date

N.B.
1. Last date of submission of form to the College by the Student - 27/03/2019
2. Students are required to submit the form along with fees to their College only.

CHALLAN COPY FOR STUDENT

(513) SAMMILANI MAHAVIDYALAYA
Received an amount of Rs.765.00 from KARTIK BARIK having Registration No. 513-1121-0387-15 and Roll No.3513-41-0108 as
examination & other fees for B.Sc. (Honours) PART-II - Examination 2019
Date (Signature of dealing person with college seal)