Confirmation Slip

Page 1 of 5

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

Approved

Sd/-

Sd/For Department

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
Chemistry & Physics,

Language Group
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):

http://www.sncadmissions.com/ApplyUG2015/PrintApplication.asp

6/5/2015

Confirmation Slip

Page 2 of 5

18. Result declared by your Board: Passed

http://www.sncadmissions.com/ApplyUG2015/PrintApplication.asp

6/5/2015

Confirmation Slip

Page 3 of 5

RESULT OF QUALIFYING EXAMINATION

Name: CHIRANTAN BANERJEE Roll: 400611 No.: 1717 Year: 2015
Board: W.B.C.H.S.E
Institution Name: PATHA BHAVAN
Institution Address: 8/2 GARIAHAT ROAD KOLKATA-700019

MARK SHEET
Sr.
1.
2.
3.
4.
5.
6.
7.

Subject
ENGLISH
HINDI
BIOLOGY
MATHEMATICS
CHEMISTRY
PHYSICS
ENVS / EED / ES

Full Marks
Theory Practical
80
20
80
20
70
30
80
20
70
30
70
30
0

Pass Marks
Marks Obtained
Theory Practical Theory Practical
24
6
70
18
24
6
53
18
21
9
59
28
24
6
32
18
21
9
36
29
21
9
55
28
0

Aggregate%
(Best Four Subjects)
82.25%
Effective Aggregate
82.25%
Merit Marks
416.00

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.

http://www.sncadmissions.com/ApplyUG2015/PrintApplication.asp

6/5/2015

Confirmation Slip

Page 4 of 5

PAY IN SLIP

IDBI BANK
DATE : 05 June 2015
Surendranath College
A/c. No. : 1398102000001137

BANK COPY

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
Surendranath College
A/c. No. : 1398102000001137

COLLEGE COPY

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
Surendranath College
A/c. No. : 1398102000001137

APPLICANT COPY

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

http://www.sncadmissions.com/ApplyUG2015/PrintApplication.asp

6/5/2015

Confirmation Slip

Page 5 of 5

Print

http://www.sncadmissions.com/ApplyUG2015/PrintApplication.asp

6/5/2015