Вы находитесь на странице: 1из 2

Application Form for WBPGAAT 2016

Form No: 16040085


West Bengal Post Graduate Ayurved Admission Test Examination
Application Date: 13-Nov-16

BIBHUTI BHUSAN
1. Candidate's Name ABHIMANYU PODDAR 2. Father's Name
PODDAR

3. Date of Birth 15-Jul-90 4. Gender Male

5. Caste General 6. Religion Hindu

7. Person with
No 8. Nationality Indian
Disability

9. Aadhar 10. Voter ID ARO1377530

12. District KOLKATA


11. Address for 6/1C COSSIPUR ROAD, WARD 6,
13. State West Bengal
Communication KOLKATA, PIN- 700002
14. PIN 700002

15. Telephone 16. Mobile 9681413739

17. Email poddarmannu786.ap@gmail.com 18. In WB Govt Service? No

20. Date/likely date of


19. University passing The West Bengal University of
completion of one year 25-Feb-15
BAMS Health Sciences
Internship

21. Registration 12246 22. Registration Type Permanent

Paschim Banga
23. Registration Date 07-Apr-15 24. Registration Council
Ayurveda Parishad

25. Pursuing any 26. Course Completion


No 01-Jan-00
course?(PG,PhD,etc) Date

27. Draft Number 007623 28. Draft Date 10-Nov-16

29. Amount 3000 30. Bank/Branch IDBI,SHYAMBAZAR

I certify that all the facts stated above are true to


best of my knowledge
Signature of candidate
Application Form for WBPGAAT 2016

Form No: 16040085


West Bengal Post Graduate Ayurved Admission Test Examination
Application Date: 13-Nov-16

Paste your passport/


stamp size photo

Attest through gazetted


officer, college
principal

Declaration by the candidate


I do hereby declare that the statements made by me in the application are true, complete and correct. In case
at any point of time any of the statements made by me are found to be false and/or incorrect, my candidate is
liable to be cancelled without further reference to me. I shall be abiding by the stipulations of the University
which will be in force from time to time for the purpose of admission and continuation of the course for which
I have applied.

Left thumb impresson of the candidate Signature of the candidate


(impression should be confined within box and (impression should be confined within box and
distinct) distinct)

No document is to be submitted with application form

Оценить