NOTE : Please verify that Form No.

will be same on all the pages like Address Slip, Main Form and Online Payment Receipt.

Address Slip (To be pasted on envelope by Applicant)

---------------------------------------------------------------------------------------------------------------------
ONLINE APPLICATION FORM FOR (AIEEA - PG - 2018)

By Speed / Registered Post To,

Form No : 1124876
1124876 The Controller of Examinations
From : SUBHANKAR BHATTACHERJEE (Agril. Edn, COE), Examination
C/O RANJAN BHATTACHERJEE, JNM Cell, Agricultural Education
HOSPITAL ROAD Division, Room No. 216, Indian
Council of Agricultural Research,
Krishi Anusandhan Bhavan-II,
Nadia, West Bengal - 741235
Pusa, New Delhi -110 012
---------------------------------------------------------------------------------------------------------------------
 INDIAN COUNCIL OF AGRICULTURAL RESEARCH PG
ICAR's 23rd All India Entrance Examination for Admission to Master Degree Programmes and Award of
ICAR-PG SCHOLARSHIP/NTS (PGS) in Agriculture and Allied Subjects including Veterinary Science for
the
ACADEMIC SESSION 2018-19
Candidate's Name: SUBHANKAR BHATTACHERJEE Form No.: 1124876

Father's Name: RANJAN BHATTACHERJEE

Mother's Name: BHARATI BHATTACHERJEE

Date of Birth: 02/11/1996 1124876

Category: SC, PC : No, Blind : No, UPS : No

Graduated Bidhan Chandra Krishi Viswavidyalaya, Mohanpur, Nadia-741 252 (West Bengal)
University:

State of Domicile: West Bengal Exam City: 1. Kolkata, 2. Delhi, 3. Nagpur

Stream: Agriculture
Sex: Male
Mobile: 9748225433 Identification ID: Driving Licence

Email Id: subhankar.1173@gmail.com Identification No: WB5120160144514

Nationality: Indian Place of Residence: Town

Thumb Impression
Visible Marks on body: CUT MARK ON LEFT HAND NEAR WRIST

Registration Date: 27/05/2018 23:21:00 Percentage of total aggregate marks obtained:

Class X: Class XII:
Print Date: 31/07/2018 20:05:32
85.57 90.400

Major Subject: 2 - Plant Sciences

Passing Year Degree Exam: 2018 Degree Name: B.Sc. (Hons.) Agriculture (4/5/6 Years)
Percentage marks or CGPA in Degree Exam: 8.240 / 10 Duration of Degree: 4 - 10+2+4 Years
College / Faculty From where graduated: Agriculture
Address: JNM HOSPITAL ROAD, Nadia, West Bengal - 741235

Please Write underlined part of the Declaration Given Below In own Handwriting:

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Declaration: I hereby solemnly affirm that all the particulars stated by me in this Application are true and correct. I have not concealed any information. However, if any
information furnished here in is fraudulent, incorrect or untrue, I understand that I am liable to criminal prosecution and I also agree to forego my admission. Further
that the selection and admission to the course is liable to be cancelled at any time during the entire degree program. I agree to abide by the rules and regulations
governing the examination as contained in the Information Bulletin, which I have duly studied and understood thoroughly.

Date: Signature of the candidate in running hand (NOT IN CAPITAL LETTERS)

I have fully read the information furnished by my son / daughter / ward and affirm that it is true and if it is found at any stage that the information is fradulent, I am
liable to criminal prosecution.

Date............................ Place........ Signature of Father / Mother / Guardian (*If Father and Mother not alive)