APPLICATION FOR PHOTOCOPY OF EVALUATED ANSWER SCRIPT(S)(FSI)

To
Application No: 0023523
The Controller of Examinations
University of Calcutta
87/1 College Street
Kolkata - 700 073.

Sir,
I would like to apply for Photocopy of Evaluated Answer Script(s) of 1 Paper for which I am furnishing my
particulars as hereunder. and remitting Rupees Five Hundred only (Rs. 500 /-) herewith.

a) Name (In Block letters) : RAJ DAS

b) Contact Address : GOT, PURBAPARA,RAJARHAT NEWTOWN,KOL-7001 57

c) Mobile No. : 8013578450

d) Name of the Examination and Year : B.COM. SEMESTER - V (HONOURS) Examination, 2023 (Under CBCS)

e) Roll No. : 211111-21-0068

(Photocopy of Admit card shall have to be attached)

f) Registration No. : : 111-1111-0233-21

(Photocopy of Regn. certificate shall have to be attached)

g) Photocopy of evaluated answer script in Subjects and Courses sought for self-inspection.
Subjects and Courses (to be written in abbreviated form as shown in the marksheet)
DSE5.2AH

DECLARATION

I declare that the above statements made by me are true to the best of my knowledge and belief and if any of
the statements is found to be false, my application shall liable to be rejected by the University without any
intimation to me .

Date : 13/05/2024 ..........................................................

N.B.
Full Signature of the Examinee

1. Last date of submission of form to the college by the student - 15/05/2024

Countersigned by the Principal .........................................................................., College

Enclosed: Please Tick( )
i) Photocopy of Admit Card
ii) Photocopy of Registration Certificate
iii) Photocopy of Gradesheet

RECEIPT COPY FOR STUDENT

Received an amount of Rs.500.00 from Received application for FSI from RAJ DAS having Registration No. 111-1111-0233-21 and Roll
No. 211111-21-0068 for B.COM. SEMESTER - V (HONOURS) Examination, 2023 (Under CBCS)

Date (Signature of dealing person with college seal)