2/29/2020

Application for PET-2020

REGISTRATION NO: BHU00625659472 PAYMENT ID: BHUP56256590415s

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: ANSHUMAN PANDA
आवेदक का नाम :
Father's Name: DAMODAR PANDA
िपता का नाम :
Mother's Name: GAYATRI PANDA
माता का नाम:
Father's / Mother's Mobile 6371679871
Number:
िपता / माता का मोबाइल नंबर :
Date of Birth: 05. May .2000
ज ितिथ :

Sex/िलंग: MALE Category/वग: General

Blood Group: A+ Do you claim Reservation for NO

ड ुप : Economically Weaker Section (EWS) ?

Physically Challenged: NO Employee's Ward: NO

शारी रक िवकलां गता: कमचारी पु पु ी :

Nationality/रा ीयता : Indian Sports Seat: NO

ोट् स सीट :
Religion/धम: HINDU
Do you belong to "BHU Student NO
Category"?:
ा आप बी.एच.यू िवदयाथ की ेणी म ह

Address For Correspondence प ाचार का पता Permanent Address थायी पता

Name: ANSHUMAN PANDA Guardian's Name (If
आवेदक का नाम Applicable)

2RP/80 SAIBABA LINE, BALIMELA Address (पता ) : 2RP/80 SAIBABA LINE, BALIMELA
Address (पता ) :

District (िजला): Malkangiri District (िजला): Malkangiri

State (रा ): Odisha State (रा ): Odisha

Pin (िपन) : 764501 Pin (िपन) : 764501

Ph. No. with STD Code Ph. No. with STD Code

Mobile No. (मोबाइल नंबर ) 8249450904 Fax No.

Mobile No. (मोबाइल नंबर) 8249450904
Email panshuman026@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 Rourkela [ Odisha ]
Preference - 02 Sambalpur [ Odisha ] Preference - 05 Dhenkanal [ Odisha ]
Preference - 03 Cuttack [ 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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