FORM Sl. No.

:10137

WEST BENGAL STATE UNIVERSITY

EXAM FORM FOR U.G. CBCS,SEM-V EXAMINATIONS 2022-23

To
The University Engineer,
In-Charge of the Office of the Controller of Examinations,
WEST BENGAL STATE UNIVERSITY
Sir,
I furnish hereunder details in support of my candidature to appear in U.G. CBCS,SEM-V Examinations 2022-23.
I shall request you to allow me to appear in the said Examination and issue Admit Card on the basis of
data furnished by me as given below.

Course : BACHELOR OF ARTS (PROGRAMME)

Name : MUNNA MONDAL
Gender : Male
Registration No. : 1392012500930
Name of the College : SREE CHAITANYA COLLEGE HABRA ( 139 )

Total Fees : Rs. 450 (Non refundable)

(* INCLUSIVE OF THEORY & PRACTICAL EXAMINATION FEES, COMPUTERISED MARKSHEET FEES,

PROCESSING FEES & HANDLING CHARGES OF THE COLLEGE Rs. 35/-)
Mode of Payment : ONLINE
Transaction No : 1392012500930_5_1221181226T57626

SUBJECTS
Sl Type Th/Prc Paper Code / Subject Name
1 DSE1 Th HISGDSE01T - HISTORY
2 DSE1 Th PLSGDSE01T - POLITICAL SCIENCE
3 GE1 Th BNGGGEC01T - BENGALI
4 SEC3 Th PLSSSEC03M - POLITICAL SCIENCE

I Declare that I have fulfilled all the criteria for appearing in Examinations as a REGULAR Candidate. I will follow all
norms of Examinations. I also declare that I have paid up all dues to the college. I attended, in the semester for which I
am filling in the form.

Yours faithfully,

N.B. Signature of the candidate

1. Examination Fees Rs. 450 *(Non refundable)
2. On completion of online submission take printouts of application form. For any query/dispute arising out in future,
copy of the form duly endorsed by the college Principal/TIC/OIC must be produced.
3. From the date of publication of Results, Answer scripts will be retained for SIX MONTHS only.
4. If someone writes Name/Regn. No./Mobile No./Roll No. on loose sheets/Answer scripts, His/Her paper will be
cancelled without showing any reason to the Candidate.
5. Student shall submit two copies of the form to their Institution/College.
6. If the details furnished by the applicant are incorrect and if He/She resorts to any malpractice, His/Her Examination
will be cancelled forthwith without showing any reason whatsoever.

Form Printed on : 21-12-2022