Government of Karnataka

Karnataka Examinations Authority

Common UG Online Application - 2024
2024

2024-25 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm
Science courses [B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental,
Ayurveda, Unani, Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2024-25

Final Copy Appln No:

3920220552460

Online Application Form

I.General Details

Candidate Name : NITHIN GANESH D C

ತಂದ Father Name/Guardian Name D K CHANDRA SHEKHAR

Mother Name CHOODA SHEKHAR

ಂ Date of Birth 17-04-2006

ಂ Mobile Number & Email 83XXXXXX25 - c****r@g****l.com

Candidate Nationality INDIAN - Resident of India

ಂ Candidate Gender MALE

Candidate Address #2/2/1, 20TH CROSS SAMPANGI RAMANAGAR

KARAGAPPA GARDEN, BENGALURU SOUTH,
BENGALURU URBAN, KARNATAKA - 560027
Caste Reservation Claimed / Income Details

Religion HINDU

Reservation category - 2A - DEVANGA

Name of the Caste

ತ ಂ RD5019267366265
Caste Certificate RD Number
ದ ತ ಂ Income Certificate RD
Number
Annual Income 120000

Other Reservation claimed Details

SCOUTS & GUIDES YES HSGSHQ-KAR-
NTTC-23S
RELIGIOUS MINORITY NO
LINQUISTIC MINORITY NO
STUDY IN KANNADA MEDIUM FROM 1 TO 10TH NO
STUDY IN RURAL AREAS FROM 1 TO 10TH NO

Printed Date: 11-02-2024 07-00-43 Page No: 1

 Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application - 2024
2024

2024-25 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm
Science courses [B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental,
Ayurveda, Unani, Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2024-25

Final Copy Appln No:

3920220552460
JAMMU & KASHMIR MIGRANTS NO
KALYANA KARNATAKA (371 (J)) NO
NRI-WARD NO

Academic Details
Quota claimed / ತ Eligibility Clause Code KARNATAKA - CLAUSE - A

ತೃ ಭ ಷ Mother Tongue KANNADA

Do you write/appearing Board Exam of 12th in Karanataka? Yes
ಂ ಂ ತ 12
Total number of years of study in Karnataka (From 1st to 12th Std.)
ಂ KARNATAKA ( STATE BOARD )
State of 2nd PUC / 12th/ Equivalent exam & Qualifying Examination Board
College Type GOVT. OF KARNATAKA
ಂ KARNATAKA ( STATE BOARD )
State of 2nd PUC / 12th/ Equivalent exam & Qualifying Examination Board
District of 2nd PUC/12th/Equivalent exam (if studied in karnatka) BENGALURU URBAN
ದ ಂ PUC Student Number & Year of 2023AN05140510 - 2024-
Passing
ಂ YES - 20220552460

Completed SSLC from KSEEB, Govt. of Karnataka? and Registration

Number
ಂತ ಂ NO

Have you Appeared for NEET Exams before 2023? / CET Number / Year of
appearance

Applied Courses
UG - CET Enggineering/Nursing/Veternary/Yoga & Naturopathy/Agriculture/Pharmacy

Exam Ceners
Exam Center (Priority 1) BENGALURU NORTH
Exam Center (Priority 2) BENGALURU SOUTH

Printed Date: 11-02-2024 07-00-43 Page No: 2

 Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application - 2024
2024

2024-25 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm
Science courses [B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental,
Ayurveda, Unani, Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2024-25

Final Copy Appln No:

3920220552460
Study Details
ಂ

Name and Address of the District ತ Passed Passed Board Area Medium
School and Address Class Year
CAMBRIDGE SCHOOL BENGALURU 1 2013 KARNATA - -
SHANTHINAGAR,No-14/15, K SOUTH KA (
H Road, Bengaluru-27 STATE
BOARD )
CAMBRIDGE SCHOOL BENGALURU 2 2014 KARNATA - -
SHANTHINAGAR,No-14/15, K SOUTH KA (
H Road, Bengaluru-27 STATE
BOARD )
CAMBRIDGE SCHOOL BENGALURU 3 2015 KARNATA - -
SHANTHINAGAR,No-14/15, K SOUTH KA (
H Road, Bengaluru-27 STATE
BOARD )
CAMBRIDGE SCHOOL BENGALURU 4 2016 State URBA English
SHANTHINAGARNo 23, K H SOUTH N
Road Bengaluru-27
CAMBRIDGE SCHOOL BENGALURU 5 2017 State URBA English
SHANTHINAGARNo 23, K H SOUTH N
Road Bengaluru-27
CAMBRIDGE SCHOOL BENGALURU 6 2018 State URBA English
SHANTHINAGARNo 23, K H SOUTH N
Road Bengaluru-27
CAMBRIDGE SCHOOL BENGALURU 7 2019 State URBA English
SHANTHINAGARNo 23, K H SOUTH N
Road Bengaluru-27
ST.JOSEPHS INDIAN HIGH BENGALURU 8 2020 State URBA English
SCHST JOSEPHS INDIAN NORTH N
HIGH SCHOOL NO 23,
VITTAL MALLYA ROAD,
BANGALORE - 01
ST.JOSEPHS INDIAN HIGH BENGALURU 9 2021 State URBA English
SCHST JOSEPHS INDIAN NORTH N
HIGH SCHOOL NO 23,
VITTAL MALLYA ROAD,
BANGALORE - 01
ST.JOSEPHS INDIAN HIGH BENGALURU 10 2022 State URBA English
SCHST JOSEPHS INDIAN NORTH N
HIGH SCHOOL NO 23,
VITTAL MALLYA ROAD,
BANGALORE - 01
Printed Date: 11-02-2024 07-00-43 Page No: 3
 Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application - 2024
2024

2024-25 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm
Science courses [B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental,
Ayurveda, Unani, Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2024-25

Final Copy Appln No:

3920220552460
ST JOSEPH INDIAN PU BENGALURU 11 2023 STATE URBA -
COLNO 2 GRANT ROAD NORTH N
(VITTAL MALLYA ROAD)
BANGALORE 560001
ST JOSEPH INDIAN PU BENGALURU 12 2024 STATE URBA -
COLNO 2 GRANT ROAD NORTH N
(VITTAL MALLYA ROAD)
BANGALORE 560001
Bank Details
Account Holder deeksha d c Bank Name canara bank
Name
IFSC Code cnrb0001175 Bank Branch sampangi ramanagar
Account Number 1175XXXXXX082

Payment Details
AppNo 3920220552460 Bank Ref No. YHD42223617106
Application Fee Rs. 600 Bank Name Bill desk
Paid Date 03/02/2024

Uploaded Documents List

SSLC/10th standard Marks Card or equivalent Certificate
Caste/Income Certificate (For SC/ST in Form-D, Cat-1 in Form-E and 2A, 2B, 3A & 3B in Form-
F Issued by the concerned Tahsildar of Karnataka)
SCOUTS & GUIDES
Passport Size Photo
Thumb Photo
Signature

1 ಂ ಂತ ಂ ಂ ದ ಂ ಂ

2 ಂ ತ ದ ತ ತ
ದ ಂದ ಂ ಂತ ದ
NOTE : 1. After completion of all the process the candidates are required to take final print out of the Online Application
Form and submit the same during Document Verification.
2. The CASTE and INCOME certificate to be produced by candidates during seat selection process should have the
same CASTE and INCOME, as mentioned in this Application Form. No change in Caste / Category will be
permitted after the final declaration.

Printed Date: 11-02-2024 07-00-43 Page No: 4

 Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application - 2024
2024

2024-25 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm
Science courses [B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental,
Ayurveda, Unani, Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2024-25

Final Copy Appln No:

3920220552460

Declaration

ಂತ ತ ಂ
ತಂ ಂ ಂ ಂ
ತಂ ಂ ಂ ಂತ ದ
ತ ತ ಂ ಂ ಂ ಂ ಂ ದ

We declare that the information furnished through online is true and correct to the best of our knowledge and
belief. We have read the instructions carefully hosted on the KEA website "Information Bulletin for Filling up of
Online Application". In case any of the information furnished online by us is found to be false or incorrect, We are
also liable for action, that the State Government or the KEA may take against us in this regard.

Left hand Thumb of

Signature of the
Candidate
Candidate

Printed Date: 11-02-2024 07-00-43 Page No: 5