2/29/2020

Application for PET-2020

REGISTRATION NO: BHU00456308472 PAYMENT ID: BHUP54563080751C

IDENTIFICATION TYPE : Aadhaar Card IDENTIFICATION NO. Not Applicable for Aadhaar Card

Course Code & Name: (472) M.Sc. - Forensic Science

पाठय म का नाम :
Candidate Name: EMIL PURTY
आवेदक का नाम :
Father's Name: SAMUEL PURTY
िपता का नाम :
Mother's Name: MARIYAM PURTY
माता का नाम:
Father's / Mother's Mobile 6371679871
Number:
िपता / माता का मोबाइल नंबर :
Date of Birth: 03. September .1999
ज ितिथ :

Sex/िलंग: MALE Category/वग: ST

Blood Group: A+ Employee's Ward: NO

ड ुप : कमचारी पु पु ी :
Physically Challenged: NO Sports Seat: NO
शारी रक िवकलां गता: ोट् स सीट :

Nationality/रा ीयता : Indian Do you belong to "BHU Student NO

Category"?:
Religion/धम: CHRISTIAN ा आप बी.एच.यू िवदयाथ की ेणी म ह

Address For Correspondence प ाचार का पता Permanent Address थायी पता

Name: EMIL PURTY Guardian's Name (If
आवेदक का नाम Applicable)

Address (पता ) : AT- J.N.V,PALJHAR Address (पता ) : AT- KUSAMURA, DEOPALI

PO- SALKI PO- CHAMUNDA

VIA SARSARA VIA- JOJOMURA

BOUDH District (िजला): SAMBALPUR

District (िजला):
Odisha State (रा ): Odisha
State (रा ):
762026 Pin (िपन) : 768105
Pin (िपन) :
Ph. No. with STD Code Ph. No. with STD Code
Fax No.
Mobile No. (मोबाइल नंबर ) 8658667845
Mobile No. (मोबाइल नंबर) 8658667845
Email emil.purty.11@gmail.com

Distance of your Residence from 1000+ Annual Income of your Between 3,00,000 and 6,00,000
BHU . Parents/Guardians in Rs.

Test Center Preference परी ा के व रयता Opted Test Mode : COMPUTER BASED TEST (CBT)
Preference - 01 Bhubaneswar [ Odisha ] Preference - 04 Cuttack [ Odisha ]
Preference - 02 Sambalpur [ Odisha ] Preference - 05 Ranchi [ Jharkhand ]
Preference - 03 Rourkela [ Odisha ]

Signature Uploaded by
the candidate
अ थ ारा अपलोडे ड
ह ा र

It is hereby confirmed that I have carefully read the concerned Information Bulletin available on the BHU's Entrance Test Portal (www.bhuonline.in) before filling up the Application Form.
I hereby solemnly affirm that the information furnished in this Online Application Form is true and correct to the best of my lnowledge and belief and no material information has been concealed or
suppressed. If any information is found to be false, incorrect or misleading, the Banaras Hindu University shall have the authority to cancel my candidature / admission without any further enquiry
or notice.
I undertake that, if admitted, I shall abide by the UGC Regulations on Curbing the Menace of Ragging, 2009, Ordinances governing the discipline of students of banaras Hindu University and
such other Rules, Ordinances and Regulations that may be framed by the Banaras Hindu University/ UGC from time to time.
I further undertake that the preference for the Test center, Courses, Domicile and the categories to which I belong as indicated by me in the online application form shall be irrevocable.

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