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:

3920220600721

Online Application Form

I.General Details

Candidate Name : MOHIT P

ತಂದ Father Name/Guardian Name PRASANNA KUMAR P M

Mother Name VEENA P

ಂ Date of Birth 29-10-2005

ಂ Mobile Number & Email 78XXXXXX71 - m****9@g****l.com

Candidate Nationality INDIAN - Resident of India

ಂ Candidate Gender MALE

Candidate Address BANNERGHATTA ROAD, NOBO NAGAR,13'TH MAIN

ROAD, SYNERGY SUNSHINE APPARTMENT.,
BENGALURU SOUTH, BENGALURU URBAN,
KARNATAKA - 560076
Caste Reservation Claimed / Income Details

Religion HINDU

Reservation category - GM -
Name of the Caste

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

Other Reservation claimed Details

RELIGIOUS MINORITY NO
LINQUISTIC MINORITY NO
STUDY IN KANNADA MEDIUM FROM 1 TO 10TH NO
STUDY IN RURAL AREAS FROM 1 TO 10TH NO
JAMMU & KASHMIR MIGRANTS NO

Printed Date: 10-02-2024 09-09-17 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:

3920220600721
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 PRIVATE
ಂ 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 2023AN06570138 - 2024-
Passing
ಂ YES - 20220600721

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
UG- Medical/Dental & Ayush (UG NEET)
UG - Para Medical Courses(BPO/BPT & AHS)
UG Architecture (NATA)

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

Printed Date: 10-02-2024 09-09-17 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:

3920220600721
Study Details
ಂ

Name and Address of the District ತ Passed Passed Board Area Medium
School and Address Class Year
PATEL PUBLIC SCHOOL, BENGALURU 1 2013 KARNATA - -
KARIYAMMANA SOUTH KA (
AG,KARIYAMMANA STATE
AGRAHARABEHIND SAKRA BOARD )
HOSPITAL BELLANDUR
POST
PATEL PUBLIC SCHOOL, BENGALURU 2 2014 KARNATA - -
KARIYAMMANA SOUTH KA (
AG,KARIYAMMANA STATE
AGRAHARABEHIND SAKRA BOARD )
HOSPITAL BELLANDUR
POST
PATEL PUBLIC SCHOOL, BENGALURU 3 2015 KARNATA - -
KARIYAMMANA SOUTH KA (
AG,KARIYAMMANA STATE
AGRAHARABEHIND SAKRA BOARD )
HOSPITAL BELLANDUR
POST
SRI CHAITANYA TECHNO BENGALURU 4 2016 CBSE URBA English
SCHOOL75/A Hulimavu SOUTH N
Bannerghatta Road
SRI CHAITANYA TECHNO BENGALURU 5 2017 CBSE URBA English
SCHOOL75/A Hulimavu SOUTH N
Bannerghatta Road
SRI CHAITANYA TECHNO BENGALURU 6 2018 CBSE URBA English
SCHOOL75/A Hulimavu SOUTH N
Bannerghatta Road
SRI CHAITANYA TECHNO BENGALURU 7 2019 CBSE URBA English
SCHOOL75/A Hulimavu SOUTH N
Bannerghatta Road
JSS GIRLS HIGH SCHOOL MYSURU 8 2020 State URBA English
SARASWATHIPURAM1ST N
MAIN, SARASWATHIPURAM
JSS GIRLS HIGH SCHOOL MYSURU 9 2021 State URBA English
SARASWATHIPURAM1ST N
MAIN, SARASWATHIPURAM
JSS GIRLS HIGH SCHOOL MYSURU 10 2022 State URBA English
SARASWATHIPURAM1ST N
MAIN, SARASWATHIPURAM
Printed Date: 10-02-2024 09-09-17 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:

3920220600721
DR NSAM PU COLL PBNO BENGALURU 11 2023 STATE URBA -
6429NO 21 NORTH N
KRISHNARAJAPURA HALLI,
SHIVAKOTE POST,
HESARAGHATTA HOBLI
BANGALORE -560089
¿¿¿¿¿¿¿¿ ¿¿¿¿¿¿
AMC AMERICAN PU BENGALURU 12 2024 STATE URBA -
COLLEGEKALKERE, SOUTH N
BANNERGHATTA NL PARK
ROAD BANGALORE 560083

Bank Details
Account Holder prasannakumar pm Bank Name HDFC Bank
Name
IFSC Code Hdfc0000261 Bank Branch Jayanagar
Account Number 0261XXXXXX4079

Payment Details
AppNo 3920220600721 Bank Ref No. YHD42230792875
Application Fee Rs. 600 Bank Name Bill desk
Paid Date 10/02/2024

Uploaded Documents List

SSLC/10th standard Marks Card or equivalent Certificate
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: 10-02-2024 09-09-17 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:

3920220600721

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: 10-02-2024 09-09-17 Page No: 5