KALINGA INSTITUTE OF INDUSTRIAL TECHNOLOGY IE been the UGC Ae SCHOOL OF MANAGEMENT MASTER OF BUSINESS ADMINISTRATION (MBA 2021-23 BATCH) (SESSION 2021-2022) REGISTRATION FORM FOR MBA - I STUDENTS (PLEASE FILL IN BLOCK LETTERS) 1, NAME OF THE CANDIDATE (As per Matriculation Certificate) : .RAIDEEP PRADHANI MARCH 1994 /. D-tve 02. DATE OF BIRTH / BLOOD GROUP 3. INDEX NO 4. FATHER'S NAME 5, FATHER'S OCCUPATION 06. MOTHER'S NAME INI PRADH ANI (07. MOTHER'S OCCUPATION 08. EMAIL ID OF PARENT(S) t (09. EMAIL ID OF STUDENT _ RAIDEEP: PRADHANS 1199 @GIMAIL:CoM 10. GENDER 11, NATIONALITY bond DIAN 12. STATE OF DOMICILE + QDISHA 13. DOCUMENTS & FEES STATUS PEN DING 14, PERMANENT ADDRESS WITH PIN CODE REMIND DAK SHINAKALL TEMPLE wn POBL 2 158 2.004 RESIDENCE TEL WITH STD CODE: MOB (MOTHER) : AAT GIO Ae. MOB (FATHER, MOB (PERSONALy 15. CORRESPONDENCE ADDRESS OEM CAE aasee REMIND. .RAKGHINAKALL TE 2.1 RESIDENCE TEL WITH STD CODE: MOB (FATHER) 2104 Mos (MOTHER) : .151.2.118.10.2.2. MOB (PERSONAL): O17 21062.7, 16. REGISTERED / PROVISIONALLY REGISTERED Declaration: 1 do hereby declare that all statements given above by me are true, complete and correct to the best of my knowledge and belief. Date: 24-06-2024 Place: Put + Bes mL Rotdeep Prada Signature of the Candidate ‘Signature of Verifying In-Charge Verification Report This is to certify that Mr./Ms. , Roll No has completed his / her registration process on and may be allowed to stay in the hostel. Signature of Verifying In-Charge School of Management Kalinga Institute of Industrial Technology Deemed to be University Bhubaneswar-24