TRIPURA CHEMICAL SOCIETY

AGARTALA
Chemistry Aptitude Test (CAT) – 2019
Regd. No. 1236/87
APPLICATION FORM *(Office use only)

STAGE – II (Class – X) Exam. Fee : Rs. 50/-

*Application Form No. ........................................................ *Roll. No. ......................................................

1. Name of the Candidate (in block letters) SRI/SMT. .........................................................................................

...................................................................................................................................................................
2. Father’s Name .............................................................................................................................................
3. Mother’s Name ...........................................................................................................................................
4. Residential address: Vill/Road ......................................................................................................................
P.O. : ................................................................... Dist : ...................................................................................
PIN : .............................................................. Phone : ....................................................................................
5. Name of the School : ....................................................................................................................................
P.O. : ..................................................................... Dist : .................................................................................
PIN : .................................................................... Phone No. ........................................................................
6. Class .......................... Sec ........................... Roll. No. ............................ Date of Birth .............................

Signature of the Head of the Institution Full Signature of the Candidate

Date and seal Date
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Chemistry Aptitude Test (CAT) – 2019

ADMIT
Stage – II (Class – X)
Application Form No. Roll No.

Name of the Examination Centre:

Date of Examination :29th Sept., 2019, Sunday

Time of Examination :10.00 AM to 11.30 AM

*Name of the Candidate:

*Name of the School:
*Candidate must write his/her name, School/Institution name during filling up the application form.
Please check in the admit card your name, School name, Centre of Examination.
Received Rs. 50/- (Fifty only) as Examination fee
General Secretary/
Competent Authority