Common Application Form

Phase-I
For Admission to Diploma (2020-21)
Directorate of Technical Education & Training, Odisha 20L0320818
Sunday, 13-Sep-2020 8:11:35 AM

Your Application is not Validated. Please Submit it at Nearest NCC.

Applicant Details

Course Details Diploma in Engineering (Lateral Only)

Applicant's Name Dibyadarshan Sahoo
Father's Name Sushanta Kumar Sahoo
Mother's Name Rajanee Sahoo
Blood Group O+ Gender MALE
Religion HINDU Date of Birth 04-Jan-2003
Aadhaar Number 681198803391

Do you belong to Building & Other Construction Workers (BOC) beneficiary? No BOC Registration No. NA

Address for Correspondence

State Odisha District Angul Block/ULB Athamallik
House No., Street/ Village, Post Office Name AT-TALABIJIPUR, P. O.-JAMUDOLI, P.S.-ATHAMALLIK
Pin Code 759125 Mobile 9178274998 Alternate Mobile No. NA
E-Mail dibyadarshansahoo1819@gmail.com

10th Examination Details

Exam Name 10th Board /Council Name Central Board of Secondary Education, 02-Community Centre, Shaiksha Kendra, Preet Vihar, Delhi-110301
Board Exam Name Secondary School Examination
Exam Type Annual Year of Passing 2018 Roll Number 6100921
Maximum Mark 500.00 Secured Mark 382.00
Have you passed the Examination Compartmentally ? No Mark Secured In First Attempt --

SL# Subject Maximum Mark Secured Mark Compartmental Mark Secured in first attempt Percentage
1 English 100 78 No -- 78.00
2 Mathematics 100 83 No -- 83.00
3 Science 100 73 No -- 73.00
4 First Language/ Odia 100 92 No -- 92.00
5 Social Science 100 56 No -- 56.00

+2 Science Examination Details

Exam Name +2 Science Board /Council Name CBSE, New Delhi
Exam Type Annual Year of Passing 2020 Roll Number 12600551
Maximum Mark 500.00 Secured Mark 352.00
Have you passed the Examination Compartmentally ? No Mark Secured In First Attempt --

SL# Subject Maximum Mark Secured Mark Compartmental Mark Secured In First Attempt Percentage
1 Chemistry 100 67 No -- 67.00
2 English 100 90 No -- 90.00
3 Informatics Practices 100 76 No -- 76.00
4 Mathematics 100 53 No -- 53.00
5 Physics 100 66 No -- 66.00

Domicile
Are you Odisha State Applicant (S) ? Yes
Resident Certificate Barcode Number/Misc. CCN e-RES/1888of2016
S-Domicile Category Permanent Resident of Odisha
District of the School Passed 10th Exam from
Are you Outside Odisha State Applicant (Z)? No
Are you Odia Living in outlying Odia Speaking Tracts (L)? No
Reservation Details (Reservation is applicable only for "S" domicile Applicants)
Category Other
Green Card (GC) NA Physically Challenged(PC) NA Children/Wards of Ex-servicemen (ES) NA
Sports NA National Cadet Corps (NC) NA

Other Information

Nationality Indian Annual Income Upto 2.5 lakh

TFW Scheme No

Payment Details

Mode of Payment Payment Status Amount Paid Transaction No.

Online SUCCESS 300 SSP29216685650

Enclosures (Certified True Copy of the following documents must be enclosed along with the CAF)

Sl# Documents
1 HSC Mark Sheets-cum-Provisional Certificate (or equivalent Board).
2 Residential Certificate from the Revenue Officer not below the Rank of Tahasildar.
3 +2 Mark Sheets-cum-Provisional Certificate (or equivalent Board).