Department of Science & Technology
and Biotechnology, Government of West Bengal
1. Personal Details
2. Professional Details
3. Academic Profesional Detail
4. Publication
5. Upload Picture
PERSONAL DETAILS
I
*
Mr.
Mrs.
Dr.
Miss.
Full First Name
*
Middle Name
Last Name
*
Father's Name
*
Date Of Birth
*
Gender
*
Male
Female
Other
Nationality
*
Indian
Others
Nationality
*
Category
*
General
OBC
SC
ST
Mobile no. (10 Digit)
*
* Input 10 digits Only
Alternate Mobile no. (10 Digit)
Email ID
*
Alternate Email ID
Permanent Residential Address
*
State
*
Andhra Pradesh
Andaman and Nicobar Islands
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadar and Nagar Haveli
Daman and Diu
Lakshadweep
Puducherry
Goa
Gujarat
Haryana
Delhi
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
District
*
Alipurduar
Bankura
Paschim Bardhaman
Purba Bardhaman
Birbhum
Cooch Behar
Darjeeling
Uttar Dinajpur
Dakshin Dinajpur
Hooghly
Howrah
Jalpaiguri
Jhargram
Kolkata
Kalimpong
Malda
Paschim Medinipur
Purba Medinipur
Murshidabad
Nadia
North 24 Parganas
South 24 Parganas
Purulia
District
*
Alipurduar
Bankura
Paschim Bardhaman
Purba Bardhaman
Birbhum
Cooch Behar
Darjeeling
Uttar Dinajpur
Dakshin Dinajpur
Hooghly
Howrah
Jalpaiguri
Jhargram
Kolkata
Kalimpong
Malda
Paschim Medinipur
Purba Medinipur
Murshidabad
Nadia
North 24 Parganas
South 24 Parganas
Purulia
City/ Town/ Village
*
P.O.
*
P.S.
*
Pin code
*
If same Present Residential Address
select
this box.
Present Residential Address
State
West Bengal
Andhra Pradesh
Andaman and Nicobar Islands
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadar and Nagar Haveli
Daman and Diu
Delhi
Lakshadweep
Puducherry
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
District
Alipurduar
Bankura
Paschim Bardhaman
Purba Bardhaman
Birbhum
Cooch Behar
Darjeeling
Uttar Dinajpur
Dakshin Dinajpur
Hooghly
Howrah
Jalpaiguri
Jhargram
Kolkata
Kalimpong
Malda
Paschim Medinipur
Purba Medinipur
Murshidabad
Nadia
North 24 Parganas
South 24 Parganas
Purulia
City/ Town/ Village
P.O.
P.S.
Pin code
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