arear2018 cucer CENTRAL UNIVERSITIES COMMON ENTRANCE TEST (CUCET-2018) Application Form Program Applied For : Post Graduate - PG Personal Details Application I PG180045061 Candidate Name ABHISHEK BANERJEE Gender MALE Date of Birth 03-Oct-1997 Ww ~ ‘Aadhar Number 405056896058 Category GENERAL Person with Disability NO Employment Status Unemployed State of Domicile WEST BENGAL Religion Hindu Kashmiri Migrant No Ward of Defence Personal NO Sports No Note**: Supemumerary quota as per PUs admission policy/ordinances. 8% supemumerary HKR quota will be applicable for CUKNK, Candidates are strongly advised to ensure that while choosing a particular PU, there exists provision of admission under such category. Father's / Guardian / ASHITAVA Father's / Guardian / Spouse ASHITAVA ‘Spouse Name BANERJEE Profession BANERJEE Mother's Name BARNALI Guardian Mobile Number 8348076683, BANERJEE ‘Communication Details hitpsieucstoxam in/CUCE Tipages!RegSiip.aspx 18arear2018 cucer Correspondence Address Address P-92,SARATCHANDRA AVENUE, Line 1: B-ZONE,DURGAPUR 5 Address P-92,SARATCHANDRA AVENUE, Line2: B-ZONE,DURGAPUR 5 City/, DURGAPUR District : Pin 713208 Code Stale: WEST BENGAL Permanent Address Address P-92,SARATCHANDRA AVENUE, Line 1: B-ZONE,DURGAPUR 5 Address Line 2 City / DURGAPUR District : Pin Code 713205 State: WEST BENGAL Name of Examination 1. Matriculation 2. 3. Graduation Exam City Details Preference 1: Kolkata Program Applied Details hitpsieucstoxam in/CUCE Tipages!RegSiip.aspx Subject SCIENCE LANGUAGE SOCIAL SCIENCE SCIENCE CHEMISTRY SchooliCollege Board/ Year of %of Name University Passing Marks Name RANIGANJ WEST 201380 HIGH SCHOOL BENGAL BOARD OF SECONDARY EDUCATION BIDHAN WEST 2015 71.2 CHANDRA BENGAL INSTITUTION COUNCIL OF HIGHER SECONDARY EDUCATION ADAMAS ADAMAS Awaited UNIVERSITY UNIVERSITY Preference 2: Asansol 28arear2018 cucer University 1: Central Program 1: Chemistry Program 2: B. Ed. Program 3: Universities of (PG111) - PGQP21 (PG001)-PGQP01 —_Environmental Science Jharkhand (PG162) - PGQP33 2: Central Program 1: Chemistry Program 2: Chemistry Program 3: Edu (PG106) - (PG105)-PGQP21 Environmental Science PGQP21 (PG159) - PGQP33 3: Central Program 1: Chemical Program 2: Chemistry Program 3: Social Universities of Tamil Lab Technician (PG108)-PGQP21 Work (PG064) - (PG113) -PGQP21 PGaP17 Declaration 1. | declare that the above furnished information is correct to the best of my knowledge. If found incorrect at any point of time, my candidature can be cancelled, 2. | undertake that | will abide by the rules and regulations of the CUCET 2018 and PU's. 3. I hereby declare that | have gone through and understood the eligibility criteria, 4,1 understand that my admission is subject to the fulfiling of eligibility criteria of the University/Programme and Program | am applying for. 5. | will be solely responsible for my eligibility and | shall be denied admission if | am not found eligible at the time of admission. Date : 09-Mar-2018 Heike | (ABHISHEK BANERJEE) Payment Status: Payment Received hitpsieucstoxam in/CUCE Tipages!RegSiip.aspx 38