UNIVERSITY OF CALCUTTA

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

Application Form for Under Graduate Examinations

Date - 08/05/2017
Application Id. - 16041384
Examination - B.Sc. PART-I (Honours) Examination - 2017
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 - DEBJIT KONAR

Father's/ Guardian's Name - INDRAJIT KONAR

Regsitration Number - 412-1121-1931-15 Roll No- 3412 - 24 - 3029

Gender - MALE

College - Code - Name - (412) DINABANDHU INSTITUTION (COLLEGE)

Subject/s to appear & Fees to be deposited:

Srl. No. Subject Code Subject Name Subject Appear Type Lab Fees (Rs.)

1 PHSG PHYSICS (GENERAL)

Examination & other Fees 355.00

Total Fees to be deposited by the candidate to the College 355.00

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 - 22/05/2017
2. Students are required to submit the form along with fees to their College only.

CHALLAN COPY FOR STUDENT

(412) DINABANDHU INSTITUTION (COLLEGE)
Received an amount of Rs.355.00 from DEBJIT KONAR having Registration No. 412-1121-1931-15 and Roll No.3412-24-3029 as
examination & other fees for B.Sc. PART-I (Honours)-2017
Date (Signature of dealing person with college seal)