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    MBA (Only) : Appln No: 3920160057375 Final

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    MBA (Only) : Appln No: 3920160057375 Final

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    22 views3 pages

    MBA (Only) : Appln No: 3920160057375 Final

    Uploaded by

    An

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Final Copy Appln No:

    3920160057375

    5Ŗ¬ltŖ4ĝOnline Application Form

    I.General Details

    Applied For M B A (only)

    4YÍħ[²lc\hCandidate Name : MANOJ S

    Q2¡l[²lc\hFather Name/Guardian Name SRINIVASA

    Ÿeĵ[²lc\hMother Name RENUKA

    dhġ¾SĨ£e2BDate of Birth 07/12/2000

    Ĺ2DGender MALE

    ū¦ltşc2‘lÍMobile Number 93XXXXXX48

    6ijsşEmail m****a@g****l.com

    ªeĽĄs[ŸlNationality INDIAN

    4YÍħ[c2VBS42•lĻ­ecCandidate's Postal Address for Communication

    Ļ­ecAddress CHANDRAYAPPA LAYOUT,1 CROSS VIJAYAPURA

    ªeIÍState KARNATAKA

    ĝ¬lÐDistrict BENGALURU RURAL (BANGALORE RURAL)

    Ÿe^iÐBhTaluk DEVANHALLI

    īŖlisŏPin Code 562135

    Academic Details
    lisšeQuota claimed KARNATAKA

    4dŸeb\QhÐlisŏEligibility Clause Code CLAUSE - A


    Īs`ƒB£eLBªeIÍSB£eLBVĸsďeZ2NĺUœlch`<Ť<Ť<şľVĸsďl[ĹÐ YES
    ŸlsDœl©eĖ\hĻªls!
    Completed SSLC from KSEEB, Govt. of Karnataka?
    Candidate SSLC/10th standard Registration Number (as per markscard) 20160057375
    ľ6ġ\VĸsďecÄ_ūS^5S͟l BENGALURU (BANGALORE )
    Exam Place for CET-2022 - First Priority
    ľ6ġ\VĸsďecÄ_<\N£ls5S͟l TUMAKURU (TUMKUR)
    Exam Place for CET-2022 - Second Priority
    Caste/ Income

    TZReligion HINDU
    —eĦ[²lc\hName of the Caste THOGATA
    IJsc¬eĦ`DReservation category 2A
    —eĦVΨePVQÎ5ģc2‘lÍ RD0038365163188
    &DVWH&HUWLILFDWH5'1XPEHU
    Printed Date: 16-12-2022 01-18-44 Page No: 1
    Final Copy Appln No:
    3920160057375

    5¡e[VΨePVQÎ5ģc2‘lÍIncome Certificate RD Number RD0038365163188


    ¨eQj§e°lMother Tongue KANNADA
    Annual Income 35000

    Study Information

    Qualifying Degree status? Appreared University seat No:(USN) C1916038


    Qualifying Degree Collage Sri Gokula College of Qualifying Degree Bengaluru North
    Name? Arts, Science & University Name? University
    Management
    Studies,Kolar
    Total Number of Years of Study in Karnataka : 12
    Qualifying Degree / Engineering Branch Bcom(3 Years) - Commerse Degree

    Particular of Result Month Passing Year of Passing Maximum Marks Secured Marks
    Examination
    1 Pass JAN 2021 1500 1188
    2 Pass SEP 2021 1700 1456
    3 Pass OCT 2022 1400 1042

    Reservation
    EX-DEFENCE NO
    KALYANA KARNATAKA RESERVATION NO

    M.TECH Program Details(Only for M.TECH Candidate)


    PGCET Appering under: M B A (only)
    PGCET EXAM Appering course name: MBA
    Have appered for gate during 2020 to 2022? No
    GATE code N/A
    GATE Score 0
    Do you claim seat under sponserd quota? No
    GATE Subject Name
    GATE Marks out of 100 0.00

    Payment Details
    AppNo 3920160057375 Bank Ref No. YHD41513455454
    Application Fee Rs. 800 Bank Name Bill desk

    Printed Date: 16-12-2022 01-18-44 Page No: 2


    Final Copy Appln No:
    3920160057375

    Paid Date 22/10/2022


    AppNo 3920160057375 Bank Ref No. YHD41507067300
    Application Fee Rs. 400 Bank Name Bill desk
    Paid Date 28/10/2022

    ęisbžlDeclaration

    75Ŗ¬ltŖZh‘e2Q\Īsģ\h`<¬eвlsĺlD_…¨eĿĦD_…UZ’lĦĺSZġ¾’lcQͲeDhĪC\®l2Sh7Zi^B
    ęisĽchŸlÃs®l75Ŗ¬ltŖ4ĝQh2Xh`ƒSl´c2X2ĩľS2Ÿl¨eĿĦltīģ[ĹвeDhl6<®lř±ltōUĹÐĪsģ\h`<¬eÐ
    ¨eĿĦciG£lD_UhÇQh2¦e<G¹ĸlĵ2S@Ĩ\hŸlÃs®l?2Sh®ls­l£e`ƒ5Ŗ¬ltŖZh‘e2Q\Īsģ\h`©e`ƒ¡ls¨eĿĦ[h
    QVƒÈ4R®e4cQÍ®l2ShB2NhX2SĹÐB£eLBVĸsďe¤eÎĩe\`ƒ7c2X2TUZÌĻ\hSÆŸl’lShli_ÑXdh¡eSeUiUhĸsĦ[
    BÎZDĺ’lXSÆ£eĖ\hŸlÃs®l
    We declare that the information furnished through online is true and correct to the best of our knowledge and belief.
    We have read the instructions carefully hosted on the KEA website "Information Bulletin for Filling up of Online
    Application". In case any of the information furnished online by us is found to be false or incorrect, We are also liable
    for action, that the State Government or the KEA may take against us in this regard.

    ¤eÎ2ah¤e^\D—lšlŏ5ĬscŝcĿPrincipal / Gazetted Officer Signature


    ²lc\hName :

    V†PcĿSignature :

    ūd\hSeal:

    DZĪľ1<¬eÐVÎĔÎĶV†P’li2NU2Q\4YÍħ[h42ĦZVÎĦ[UhÇZhĨÎľli2Nh¡eC¬l
    œeBhÍij2ō Vĸļs^£lc2SYSĹÐ
    BœeÀ[®eĖcĹÐc¦lsBh
    2ľsLhd2ělVÎĔÎĶ[cZ[SĹÐ?SĖch`—eĦZQhÃ5¡e[VΨePVQÎ`ƒ5Ŗ¬ltŖ4ĝ[cZ[SĹÐUZiĨľS—eĦZQhÃ
    5¡e[`ƒBœeÀ[®eĖ?2¡ls5Ė\¦lsBh42ĦZęisbžl[U2Q\©e`ƒ¡lse\PBi´—eĦ[ĹÐXS¬e`žl’l4`eaĻ\h`ƒĨ^Ð
    NOTE : 1. After completion of all the process the candidates are required to take final print out of the Online Application Form
    and submit the same during Document Verification.
    2. The CASTE and INCOME certificate to be produced by candidates during seat selection process should have the
    same CASTE and INCOME, as mentioned in this Application Form. No change in Caste / Category will be permitted
    after the final declaration.

    21/10/2022

    Declared Date 4YÍħ[cĿ


    Left hand Thumb of
    Candidate Signature of the
    Candidate

    Printed Date: 16-12-2022 01-18-44 Page No: 3

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