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APPLICATION FORM FOR COMEDK PGET-2014
For those intending to apply to member institutions seeking admissions to
1st Year Postgraduate Programme for Medical/Dental during 2014-2015
Applicant Details
Application Number: 808944
Name of the Applicant: DEBASHISH BHATTACHARJEE
Please affix your
recent passport size
colour photograph
here
Signature of the Candidate
(within the box)
Re-Entered Applicant
Name:
DEBASHISH BHATTACHARJEE
Date of Birth: 25/08/1988
Re-Entered DOB: 25/08/1988
Course applying for: MEDICAL
Gender: MALE
Nationality: INDIAN
Parents/Applicant Annual
Income:
Rs.800000 /-
Belongs to: NON-KARNATAKA
By Birth / Domicile:
Category Details
Category: GM
Re-Entered Category: GM
Permanent Address Correspondence Address
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Address: 16/1 MOTIJHEEL AVENUE
FLAT 4E
DUMDUM
Address: 16/1 MOTIJHEEL AVENUE
FLAT 4E
DUMDUM
City: KOLKATA City: KOLKATA
State: WEST BENGAL State: WEST BENGAL
Pincode: 700074 Pincode: 700074
Phone No.: Mobile No: 9804353974
Email ID: JOYRAMAKRISHNA@GMAIL.COM
Payment Details Demand Draft (DD) Only
DD No.: 216032 DD Amount: Rs.2250 /-
DD Date: 05/12/2013 Drawee Bank: STATE BANK OF INDIA
Academic Details
Qualifying Exam: M.B.B.S Type of University: INDIAN
Month / Year of Passing: 03/2012
University last
studied:
WEST BENGAL UNIVERSITY OF
HEALTH SCIENCES,KOLKATA
Completed / would be completing Internship by 30/04/2014: COMPLETED
Month / Year of completing Internship:
No. of Attempts in COMEDK
PGET: 0 Result:
Marks Obtained in the Qualifying Examination (M.B.B.S. / B.D.S.)
Year Maximum Marks Marks Obtained Grade Obtained No. of Attempts
I Year 600 349 1
II Year 550 307 1
III Year 400 254 1
IV Year 900 544 1
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IV Year 900 544 1
TOTAL 2450 1454 4
Declaration : I hereby declare that the particulars given in this form are true to the best of my knowledge &
belief.
sign
Date : Place :
Application No : 808944
Applicant Name : DEBASHISH BHATTACHARJEE
Signature of the Candidate
(within the box)
Please affix your
recent passport size
colour photograph
here (inside the
box)
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