2/29/2020

Application for PET-2020

REGISTRATION NO: BHU00523240472 PAYMENT ID: BHUP55232400860I

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: SAPNA AGRAWAL
आवेदक का नाम :
Father's Name: SIV SANKAR AGRAWAL
िपता का नाम :
Mother's Name: PAYAL AGRAWAL
माता का नाम:
Father's / Mother's Mobile 8018538789
Number:
िपता / माता का मोबाइल नंबर :
Date of Birth: 12. October .1999
ज ितिथ :

Sex/िलंग: FEMALE Category/वग: General

Blood Group: AB+ 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: SAPNA AGRAWAL Guardian's Name (If
आवेदक का नाम Applicable)

AT/PO- KANTAMAL Address (पता ) : AT/PO- KANTAMAL

Address (पता ) :
VIA- MANAMUNDA VIA- MANAMUNDA

District (िजला): BOUDH District (िजला): BOUDH

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

Pin (िपन) : 762017 Pin (िपन) : 762017

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

Mobile No. (मोबाइल नंबर ) 8917234750 Fax No.

Mobile No. (मोबाइल नंबर) 8917234750
Email sapnaagra1299@gmail.com

Distance of your Residence from 1000+ Annual Income of your Less than 2,00,000
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 Cuttack [ Odisha ] Preference - 05 Dhenkanal [ Odisha ]
Preference - 03 Sambalpur [ 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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