GOVERNMENT OF BIHAR

Bihar Combined Entrance Competitive Examination Board

Diploma Certificate Entrance Competitive Examination - 2022

Online Application Form for admission in Various Diploma Courses of Govt. / Pvt. Polytechnic
Institutions of Bihar and Various Para Medical Matric (Matric Level) and Para Medical (Intermediate
Level) of Different Govt. / Pvt. Recognised Hospitals / Institutions (as per prospectus) for the Session 2022.
Registration No. Please donot send this Hard Copy to BCECE Board
4220199390

PART- A
 
1. Name of Examination : DCECE-2022
2. Course Group Applied For : PM
3. Candidate's Name : VARSHA KUMARI
4. Father's Name : MAHESH MAHTO
5. Mother's Name : NISHA DEVI
6. Date of Birth : 5-MAR-2005
7. Gender : FEMALE
8. Category : EBC (EXTREMELY BACKWARD  
CLASS)
9. Disabled Quota : NO
 
10.Percentage of Disability :
N/A
11.If you unable to write due to :
N/A
permanent loss of limbs / Note: Please Affix your same photo and put your full
suffering from Cerebral signature in English and Hindi in spaces provided above.
palsy, then do you claim for
providing Scribe

12. Mobile No. : 754XXXX472

13. Email ID : VARSHAKBGS05@GMAIL.COM
14. Aadhaar Card No. : 5615XXXXXXXX
15. Are you permanent resident of Bihar. : YES
16. Residential Eligibility : माता / पिता / पति / पत्नी बिहार के स्थायी / मूल निवासी है।
17. Is your Family (Father/Mother) annual income is less :
than 8 Lakhs
18. Do you Claim for Service Men's Quota (SMQ) :
19. Are you
Unmarried Daughter
of Ex-Servicemen / :
Retired / Serving Military Personnel
20. District Name of the Institution of Passing/Appearing in :
BEGUSARAI
Qualifying Exam
21. Mark of Identification : A MOLE ON LEFT CHEEK
22. Your Educational Qualification/Experience for PPE :
N/A
23. ITI Name :
N/A
24. ITI Trade :
N/A
25. Are You employed as Technical Supervisor/Class III or :
N/A
holding any Class III technical post in a registered
Govt./Semi Govt./Non Govt.Industries/Organization
situated within 50 K.M radius from Govt. Polytechnic,
Patna-13
26. Are You Producing the certificate issued by the :
N/A
authorized head authority of the registered Govt./Semi
Govt./Non Govt.Industries/Organization mentioning
there in the applicants period of Employment his work
experience and sponsoring the applicants for appearing
in Entrance Examination for Four year Part time
Polytechnic Engineering Course
27. Have you already completed ANM Course :
N/A
Registration No. 4220199390
 28. Educational Qualification:

Level Passing Passing School / Board / Subject Marks Type Total Marks % of
Status Year College University Marks Obtained marks
/
CGPA
SECONDARY/STANDARD PASSED 2020 C M HIGH BIHAR SCHOOL ALL PERCENTAGE 500 254 50.80
X SCHOOL EXAMINATION SUBJECTS
CHHITRAPUR, BOARD
BEGUSARAI
I.SC./XII (10+2) PASSED 2022 B.N.KANYA BIHAR SCHOOL PCB PERCENTAGE 500 260 52.00
COLLEGE, EXAMINATION
BARAUNI, BOARD
BEGUSARAI

29. Payment Details:

Payment Mode Transaction No. Deposit Date Amount (in Rs.)

Online 692190706220305862 07/06/2022 03:38:06 pm 750.00

30. Address Details:

A. Permanent Address: B. Correspondence Address:
Village/Mohalla: NAGDAH, WARD NO. 10
Village/Mohalla: NAGDAH, WARD NO. 10

Post: NAGDAH
Post: NAGDAH

Police Station: MUFFASIL

Police Station: MUFFASIL

District: BEGUSARAI
District: BEGUSARAI

State: BIHAR, Pin Code: 851117. State: BIHAR, Pin Code: 851117.

Declaration by the Candidate: I VARSHA KUMARI declare that the informations furnished above are correct and I
shall forfeit my candidature and will be liable for legal action in case of any of them is proved to be false at any stage
inclusive of admission or thereafter.

Date: ....................
Place: ..................... (Signature in English) (Signature in Hindi)

Registration No. 4220199390

 GOVERNMENT OF BIHAR

Bihar Combined Entrance Competitive Examination Board

Diploma Certificate Entrance Competitive Examination - 2022

Online Application Form for admission in Various Diploma Courses of Govt. / Pvt. Polytechnic
Institutions of Bihar and Various Para Medical Matric (Matric Level) and Para Medical (Intermediate
Level) of Different Govt. / Pvt. Recognised Hospitals / Institutions (as per prospectus) for the Session 2022.

Registration No. Please donot send this Hard Copy to BCECE Board
4220199390

PART- B

(For office use only)

Selected for admission (First Selected for admission (Second Selected for admission (Mop-Up

Counselling)
Counselling)
Counselling)

Against Roll No............................................... Against Roll No............................................... Against Roll No...............................................

Reservation Category.................................... Reservation Category.................................... Reservation Category....................................

Merit Serial ..................................................

Merit Serial ..................................................
Merit Serial ..................................................

at....................................................(institution)
at....................................................(institution)
at....................................................(institution)

in...................................... (Course/Branch) in...................................... (Course/Branch) in...................................... (Course/Branch)

Signature
Signature of the Controller of Signature
Signature of the Controller of Signature
Signature of the Controller of
of the
verifying Officer
Examination
of the
verifying Officer
Examination
of the
verifying Officer
Examination

Candidate
DCECE-2022 BCECEB Candidate
DCECE-2022 BCECEB Candidate
DCECE-2022 BCECEB
(At the time of (At the time of (At the time of
Counselling) Counselling) Counselling)

1. Name of Examination : DCECE-2022  

2. Course Group Applied For : PM
3. Candidate's Name : VARSHA KUMARI
4. Father's Name : MAHESH MAHTO
5. Mother's Name : NISHA DEVI
6. Date of Birth : 5-MAR-2005
7. Gender : FEMALE
8. Category : EBC (EXTREMELY BACKWARD
CLASS)  
9. Disabled Quota : NO
10.Percentage of Disability :
N/A  
11.If you unable to write due to :
N/A
permanent loss of limbs /
suffering from Cerebral Note: Please Affix your same photo and put your full
palsy, then do you claim for signature in English and Hindi in spaces provided above.
providing Scribe

12. Mobile No. : 754XXXX472

13. Email ID : VARSHAKBGS05@GMAIL.COM
14. Aadhaar Card No. : 5615XXXXXXXX
15. Are you permanent resident of Bihar. : YES
16. Residential Eligibility : माता / पिता / पति / पत्नी बिहार के स्थायी / मूल निवासी है।
17. Is your Family (Father/Mother) annual income is less :
than 8 Lakhs
18. Do you Claim for Service Men's Quota (SMQ) :
19. Are you
Unmarried Daughter
of Ex-Servicemen / :
Retired / Serving Military Personnel
20. District Name of the Institution of Passing/Appearing in :
BEGUSARAI
Qualifying Exam

Registration No. 4220199390

21. Mark of Identification : A MOLE ON LEFT CHEEK
22. Your Educational Qualification/Experience for PPE :
N/A
23. ITI Name :
N/A
24. ITI Trade :
N/A
25. Are You employed as Technical Supervisor/Class III or :
N/A
holding any Class III technical post in a registered
Govt./Semi Govt./Non Govt.Industries/Organization
situated within 50 K.M radius from Govt. Polytechnic,
Patna-13
26. Are You Producing the certificate issued by the :
N/A
authorized head authority of the registered Govt./Semi
Govt./Non Govt.Industries/Organization mentioning
there in the applicants period of Employment his work
experience and sponsoring the applicants for appearing
in Entrance Examination for Four year Part time
Polytechnic Engineering Course
27. Have you already completed ANM Course :
N/A
28. Educational Qualification:
Level Passing Passing School / Board / Subject Marks Type Total Marks % of
Status Year College University Marks Obtained marks
/
CGPA
SECONDARY/STANDARD PASSED 2020 C M HIGH BIHAR SCHOOL ALL PERCENTAGE 500 254 50.80
X SCHOOL EXAMINATION SUBJECTS
CHHITRAPUR, BOARD
BEGUSARAI
I.SC./XII (10+2) PASSED 2022 B.N.KANYA BIHAR SCHOOL PCB PERCENTAGE 500 260 52.00
COLLEGE, EXAMINATION
BARAUNI, BOARD
BEGUSARAI

29. Payment Details:

Payment Mode Transaction No. Deposit Date Amount (in Rs.)
Online 692190706220305862 07/06/2022 03:38:06 pm 750.00

30. Address Details:

A. Permanent Address: B. Correspondence Address:
Village/Mohalla: NAGDAH, WARD NO. 10
Village/Mohalla: NAGDAH, WARD NO. 10

Post: NAGDAH
Post: NAGDAH

Police Station: MUFFASIL

Police Station: MUFFASIL

District: BEGUSARAI
District: BEGUSARAI

State: BIHAR, Pin Code: 851117. State: BIHAR, Pin Code: 851117.

31.(A) Declaration of Candidate:

(अभ्यर्थी द्वारा घोषणा)

“मेरे द्वारा ऊपर अंकित की गयी सभी प्रविष्टियाँ सही हैं तथा इनकी सत्यता की पूरी जिम्मेवारी मेरी है| प्रविष्टियों के असत्य / अपूर्ण पाये जाने पर स्वतः आवेदन /
नामांकन रद्द होने के साथ-साथ कानूनी दंड का मैं भागी होऊँ गा / होऊँ गी| संस्थान में नामांकन होने की स्थिति में मैं संस्थान के नियमों एवं अनुदेशों का पुर्णतः पालन
करूँ गा / करुँ गी|”

उपर्युक्त घोषणा को स्वहस्तलिपि में निचे लिखें :

 

Place: ....................

Date: .....................
आवेदक का पूरा हस्ताक्षर हिंदी में Candidate's Full Signature

(in English) (Not in Capital letters)

Registration No. 4220199390
(B) Declaration of Father/Mother/Husband/Spouse/Guardian
(पिता / माता / पति / पत्नी / अभिभावक द्वारा घोषणा)

मैं ........................................... (नाम) घोषित करता हूँ कि श्री / श्रीमती ............................................... के नामांकन के बाद इनके पाठ्यक्रम की अवधि में उचित
चरित्र एवं इनके ऊपर किसी तरह की बकाया राशि के लिए जिम्मेदार हूँ| मैं पुनः प्रमाणित करता / करती हूँ कि इनके द्वारा इस आवेदन में दिए गये उपरोक्त सभी
विवरणी सही हैं|

Place: ....................
((पिता / माता / पति / पत्नी / अभिभावक)
Full Signature of
का पूरा हस्ताक्षर हिंदी में) Father/Mother/Husband/Spouse/Guardian

in English (Not in Capital letters)

Date: .....................
32. List of Enclosure:

1. 2.

3. 4.

5. 6.

7. 8.

Registration No. 4220199390

33.

AT THE TIME OF FIRST COUNSELLING/INTERVIEW ONLY)

(i) Full signature of the candidate
(ii) L.T.I of the Candidate

(English) .......................

(Hindi) .......................

AT THE TIME OF SECOND COUNSELLING/INTERVIEW ONLY)

(i) Full signature of the candidate
(ii) L.T.I of the Candidate

(English) .......................

(Hindi) .......................

AT THE TIME OF MOP-UP COUNSELLING/INTERVIEW ONLY)

(i) Full signature of the candidate
(ii) L.T.I of the Candidate

(English) .......................

(Hindi) .......................

34.

(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF FIRST COUNSELLING)
Roll No. ........................................ Reservation Category .................................... Merit Serial ..................... of DCECE(PE/ PPE/
PM/ PMM)- 2022 in the First Year of ............................... Course/Branch of the Institute ................................................ as
He/She fulfilled all the requirements of being admitted.

SEAL OF THE INSTITUTE

SIGNATURE OF THE
DIRECTOR/PRINCIPAL

(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF SECOND COUNSELLING)
Roll No. ........................................ Reservation Category .................................... Merit Serial ..................... of DCECE(PE/ PPE/
PM/ PMM)- 2022 in the First Year of ............................... Course/Branch of the Institute ................................................ as
He/She fulfilled all the requirements of being admitted.

SEAL OF THE INSTITUTE

SIGNATURE OF THE
DIRECTOR/PRINCIPAL

(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF MOP-UP COUNSELLING)
Roll No. ........................................ Reservation Category .................................... Merit Serial ..................... of DCECE(PE/ PPE/
PM/ PMM)- 2022 in the First Year of ............................... Course/Branch of the Institute ................................................ as
He/She fulfilled all the requirements of being admitted.
SEAL OF THE INSTITUTE
SIGNATURE OF THE
DIRECTOR/PRINCIPAL

Registration No. 4220199390