Candidate's Details

Application Number : 349889

1 Course/s Applied for PGCET : M B A (only)FullTime

2 Name of the Candidate : ARCHANA D

3 Name of the Father : GOVINDAPPA D
4 Name of the Mother : GEETHA D
5 Date of Birth : 18:10:1997
6 Gender : Female 7 Quota : Non Karnataka
8. Marital Status Single Spouse Name

9. Annual Income of the family from All Sources (If married include your spouse 65000
income also)
10 Category : General Merit 10 a. Sub-Caste :
Income RD Number (RD00-------)
Caste RD Number starting with (RD0--------)

11 Religion : Hindu
12 Eligibility Clause Code: a
13 Qualifying Degree / Engineering Branch ? B.Com (3 Years Degree)

Study Information
Have You done BCA, BSc (I.T / Computer Science ) with Mathmatics at 10+2 level or at No
Graduate Level ? (for Lateral entry to 2nd Year MCA )
Qualifying Degree Status ? Appeard University Seat No : (USN) 15TXC41112
Qualifying Degree College Name : SRI KRISHNA DEGREE Qualifying Degree University BANGALORE UNIVERSITY
COLLEGE Name :
Total Number of Years of Study in Karnataka : 15
Particulars of Result Month of Passing Year of Passing Maximum Marks Secured Marks
Examination
1 Pass May 2016 1500 1205

2 Pass May 2017 1700 1416

14 Do You Claim Reservation Under Physically Disabled Quota ? No

15 Do You Claim Reservation Under Ex-Serviceman Quota ? No
16 Do You Claim Reservation Under 371(J) (Hyderabad Karnataka) Quota ? No
16 (a) 371(J) RD Number starting with (RD0--------)

M.Tech Program Details (Only for M.tech Candidates)

PGCET Appearing under :

PGCET Exam Appearing Course Name :

Have you Appeared for GATE during 2017 or 2018 ?

GATE Code :

GATE Score : 0

Do You Claim Seat under Sponsered Quota?

17. PGCET Examination Centre BANGALORE(BENGALURU)

Candidate's Postal Address for Communication

Address : NO 28 1ST A CROSS SUMUKHA LAYOUT,CHIKKALASANDRA , NEAR ARRAIAH NAIDU STUDIO,
,BANGALORE - 560061BENGALURU SOUTH,BANGALORE URBAN (BENGALURU),KARNATAKA-
560061
Mobile No : 8884210385
Email : d.archana1122@gmail.com

Declaration
 I declare that the above information is true and correct to the best of my knowledge and belief. I have gone through the
relevant Government Orders, Admission Rules and all Notifications / Website Notification issued by competent Authorityfor
PGCET-2018 and understand the same.If any of the information furnished above is found to be false or incorrect, I shall
automatically forfeit my claim to be considered for a seat or the seat already been opted by me in a Professional College in
Karnataka. In such event, I will also liable for such civil and criminal action as the State Government / KEA may take against me
in this regard.

Signature of the Left Hand Thumb impression of Date:

Candidate the Candidate

Principal / Gazetted Officer Signature

Name:
Signature:

Seal:

PAYMENT STATUS
Appno : NAME OF THE CANDIDATE :
APPLICATION FEES : BANK NAME :
BANK CHARGES : BANK Ref NUMBER :

Printed Date 04-06-2018 09-10-56