107834_2.pdf
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APPLICATIONFORM
5 Year BS-MS Dual Degree Programme(2016)
Your Application Number is107834. Please quote this number in any further communications.
Please take a printout of this document and bring it along with you at the time of admission.
Admission channel: SCB
Name: Kiran Raj R
Date of Birth: 1998-04-18
Gender: Male
Category: GENERAL
Person with Disability: No
Kashmiri Migrant: No
Address for correspondence: TYPE IV QTRX MEDICAL COLLEGEMULANKUNNATHKAVU
THRISSUR, Kerala
Pin code: 680596
Guardians Name: Anitha Kumari R
Contact Number: 9497625007
Alternate Contact Number: 8089774075
Email: [email protected]
Percentage marks in 10+2: 93.8
Board: CBSE
Year of passing XII: 2016
Apt. Test Center/Language: Kochi / English
Preference of
IISERs:1. Pune
2. Thiruvananthapuram
3. Tirupati
4. Kolkata
5. Berhampur
6. Bhopal
7. Mohali
Opted to Float: Yes
Subject-wise Marks
ENGLISH CORE 92.00/100.00
MATHEMATICS 91.00/100.00
PHYSICS 95.00/100.00
CHEMISTRY 95.00/100.00
BIOLOGY 96.00/100.00
Payment Details
Transaction ID: YES-031408559403606
Amount: INR 1500.0
Date/Time of payment: 2016-05-29 23:42:09
Undertaking from the candidate and guardian
I,Kiran Raj R, S/o, D/o, Ward/o Anitha Kumari Rhereby declare that
1. The information provided by me in this application form is true and based on verifiable records.
2. I undertake to present the original documents immediately upon demand by IISER(s).
3. I understand that even if I get admitted to IISERs, it does not necessarily entitle me for a fellowship.
4. I understand that a false information provided by me in the application form or any of the supporting documents will lead to the forfeiture of
my candidature at any stage of the admission process, or thereafter.
The decision of the Chairperson, Joint Admissions Committee 2016 will be final in case of any dispute.
(Signature of the Applicant) (Signature of the Guardian)
KIRAN RAJ R ANITHA KUMARI R
Date:
Place:
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Undertaking from the candidate and guardian
I,Kiran Raj R, S/o, D/o, Ward/o Anitha Kumari Rhereby declare that
1. The above image is a scanned copy of my marksheet.
2. I understand that a false information provided by me in the application form or any of the supporting documents will lead to the forfeiture of
my candidature at any stage of the admission process, or thereafter.
The decision of the Chairperson, Joint Admissions Committee 2016 will be final in case of any dispute.
(Signature of the Applicant) (Signature of the Guardian)
KIRAN RAJ R ANITHA KUMARI R
Date:
Place:
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