OJEE FORM F - Application Form for B.

Tech (SPECIAL)
2021
(SPECIAL) 2021
Confirmation Page

Application No. 2140 6100 0550 -

DO NOT SEND THIS PAGE TO BOARD.
CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Section
Candidate's Name MANAS RANJAN SAHOO Date of Birth 05-02-2004
Mother's Name DAMAYANTI SAHOO Birth Category General
Father's Name LOKANATH SAHOO Gender Male
Physically Challenged No Sub Category Green Card (GC)
Nationality Indian Annual Family Income More than 8 Lakhs
Domicile ODISHA

Applying For
Apply For B.Tech (08) Exam City 1st ODISHA - Dhenkanal (016)
Exam City 2nd ODISHA - Bhubaneswar (014) Exam City 3rd ODISHA - Cuttack (015)

Education Details
Qualification Pass Status Course/Stream Board/University Year of Result Marks Detail RollNo/ Institute Pincode
Name Name Passing/appe Mode Enroll Name &
aring No. Addres
s
12th or Appearing 10+2 Science COUNCIL OF HIGHER 2021 NA NA 335DA0 GODTA 759101
equivalent SECONDARY 30 L
EDUCATION, ODISHA REGIO
NAL
HIGHER
SECON
DARY
SCHOO
L

Contact Details
Address ADHEIMUNDI Locality
City/Town/Village RANGANIPATNA District ANGUL
State ODISHA Pin Code 754037
Email Address smi**************@gmail.com Mobile Number 784****286
Land Line No. with --
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Online Payment Transaction ID: WUR20138095506
Exam Fee: 1000 /- Date of Transaction: 24/07/2021 18:21:37
Fee Submitted On: 24/07/2021
DECLARATION
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read and understood the Board
procedures. I shall abide by the terms and conditions thereon.

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