INDIAN INSTITUTE OF SCIENCE, Application No

BANGALORE - 560012 18730467

APPLICATION FORM FOR ADMISSION TO
BACHELOR OF SCIENCE (RESEARCH) PROGRAMME
2018
Name of the Candidate : Mr. KHOZEMA BHAVNAGARWALA
(as it appears in your SSLC/10th Standard Certificate)
Gender : Male Nationality : Indian
Category : General
Date of Birth : 29 Jun 2000 State of Domicile : Maharashtra
Mother Tongue : Gujarati
Address for 604 SARAH HEIGHTS MAULANA SHAUKAT ALI RD,
Correspondence : GRANT ROAD,
MUMBAI, Maharashtra
PIN Code : 400007
E-mail Address : bhavnagarwalakn@gmail.com
Phone Number : - Mobile Number : +91 - 8850376196

National Entrance Test Details :

National Entrance Test Year Seat No. / Roll No. / Admit Card Rank/Mark
No.
NEET-UG 2018 50831904 -

Previous Entrance Test Details :

Educational Qualification :
Schooling Year of Institution / Board % of Grade Subjects
Passing School Marks/
CGPA
10th Std 2016 ST PETERS Delhi 91.83 N/A N/A,
SCHOOL,
MAZGAON
12th Std 2018 JAI HIND Maharashtra N/A N/A Biology,Chemistry,Mathematics,N/A,
(Appeared/Appea COLLEGE, Physics,HINDI ,ENGLISH
ring) CHURCHGATE

How did you come to know about the BS Programme : IISC Website
Declaration :
I hereby sincerely affirm that all the statements made and information furnished by me in the application form are true and
correct.I agree to abide by the Rules and Regulations governing of Indian Institute of Science if admitted to the programme.

I understand that I need to update the final roll No. and the rank of the entrance exam as and when it is made available (within
one week), failing which my application my not be Processed.

Place : MUMBAI

Date : 25/04/2018 Signature of the Applicant

Place : MUMBAI

Date : 25/04/2018 Signature of

Father/Mother/Guardian
'Preview copy' submitted by Mr. KHOZEMA BHAVNAGARWALA on Apr 25 2018 8:35AM