Common Application Form

Common PG Entrance Test, Academic Session (2024-25)

Higher Education Department, Government of Odisha 24P1381654
Sunday, May 26, 2024 11:49:10 AM

Personal Details
Applicant's Name : MAHAMMED SAHAJAHAN
Father's Name : MAHAMMED JAHANGIR
Mother's Name : HAMIDA BIBI
Blood Group : O+ Gender : MALE
Religion : MUSLIM Date of Birth : 13-Mar-2001
Identification Type : AADHAAR Identification No : ********3642

State of Domicile : APAAR ID : NOT

ODISHA
PROVIDED

Address for Correspondence

Details(Plot/Flat/Building/Village) : AT/PO- PALANK, BRAHMAGIRI, Block / ULB : BRAHMAGIRI

PURI
District : PURI State : ODISHA
PIN Code : 752011 Mobile No. : 7978220439
Whatsapp No. : 7978220439 Alternative Mobile No. : NA
e-Mail : mahammedsahajahan@gmail.com Residence Certificate Barcode : NOT PROVIDED
Issuing Authority : NOT PROVIDED Issuing Date : NOT PROVIDED

Reservation Details
Social Category : GENERAL PWD : NO
Sub Category : NONE Applicant's welfare Classification : NA

Weightage Details
NCC : NA NSS : NA
Rover & Ranger : NA Sports & Games : NA

Graduation Examination :APPEARED

Educational Qualification

+2 Equivalent/Stream : SCIENCE

Name Of The Examination Stream / Mark Board / University Year Of Roll Max Marks Secured %
Class Type Passing No. / CGPA Marks / CGPA Secured

GRADUATION/EQUIVALENT LAW(LLB) CGPA MADHUSUDAN LAW 2024

UNIVERSITY

Note: If you have entered incorrect details (not having at least 24 credits but mentioned the same), your candidature will be cancelled during admission and
document verification process.

Graduation Subject
Passed Graduation With ? : NA
Subject : LAW

Subject For PG Entrance Examination

SL# Subject
 1 LAW (LLM)

Preference Of Examination Zone

BHUBANESWAR

Payment Details

Payment Date Payment Amount Transaction Number Payment Mode Payment Through

26-May-2024 500.00 IGARHQLOW1 NB SBIEPAY

Bank Account Details

Account Number : 36165036421 IFSC Code : SBIN0012038
MICR Code : 752002505 Bank Name : STATE BANK OF INDIA
Branch Name : BRAMHAGIRI

Income details
Mother's
Father's Occupation : BUSINESS HOME MAKER
Occupation :
Annual Income of the
0 to 1.5 Lakh Actual Income : 60000.00
parents(together) in Rs. :
To Whom the
Income Certificate Barcode : NOT PROVIDED Certificate is NOT PROVIDED
Issued :
Issuing Authority : NOT PROVIDED Issuing Date : NOT PROVIDED

Other Information
Special Category (For GSSY Scholarship) : None of these
Does your parents qualify as beneficiaries for KALIA Yojana? : Yes
Does your parents hold a Labour card? : No

Scholarship Scheme

No Records

Declaration

I MAHAMMED SAHAJAHAN ,solemnly affirm that the information furnished above is true and correct in all respect to the best of my knowledge
and belief. I have not concealed any information. I undertake that if any information herein is found to be incorrect or false, I shall be liable for
action as per rules in force.

Note:- The CAF Fees of the applicants coming under "welfare classification" will be refunded after verification by the concerned DCPO and DSWO.

Date:

Place: Signature of Applicant

5/26/2024 11:49:11 AM