243551615493 ApplicationForm

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COMMON UNIVERSITY ENTRANCE TEST

CUET (UG) - 2024


Confirmation Page

Application Number 243551615493


Do Not Send this Page to National Testing Agency (NTA).
Candidate is requested to retain the printout of Confirmation page for future Reference.
यितगत योरा (Personal Details)
एबीसी आईडी (Abc ID) 243551615493
उमीदवार का नाम (Candidate उमीदवार की जम ितिथ (Candidate
Shakti Swaraj Das 25-02-2006
Name) Date of Birth)
िपता/अिभभावक का नाम माता/अिभभावक का नाम
Suresh Chandra Das Rajalaxmi Das
(Father/Guardian Name) (Mother/Guardian Name)
िलंग (Gender) Male राटीयता (Nationality) Indian
Any Other Valid Govt Identity पहचान संया (Identification
पहचान का कार (Identity Type) 870297238605
With Photograph Number)
वग (Category) General राय का अिधवास (State Domicile) Odisha
या आप पीडयूडी उमीदवार ह  (Are you a PwD Candidate?) No
िपता/अिभभावक की योयता
िपता/अिभभावक का यवसाय
(Father /Guardian Post Graduate Others
(Father/Guardian Occupation)
Qualification)
माता/अिभभावक योयता (Mother माता/अिभभावक का यवसाय
Graduate Others
/Guardian Qualification) (Mother/Guardian Occupation)
या आपको मधुमेह ह  (Are you वािषक पािरवािरक आय (Annual
No Rs. 200001 – 300000
Diabetic?) Family Income)
या आप जु ड़वां ह और दोनों CUET-UG 2024 के िलए आवे दन कर रहे ह
No
(Are you twin and both applying for CUET-UG 2024)
िनवास की जगह (Place Of तैयारी का तरीका (Mode of
URBAN Self-study
Residence) Preparation)
योयता परीा म अययन का
मायम (Medium of Study in English
Qualifying Examination)
अय कोटा े णी िववरण (Other Quota Category Details)
या आप गरीबी रे खा से नीचे ह  (Do
या आप कमीरी वासी ह  (Are you
you belong to Below Poverty No No
Kashmiri Migrant ?)
Line ?)
रा कािमक/पूव सै िनकों का वाड
एनसीसी कोटा के िलए दावा (Claim for
(Ward of Defence Personnel / No No
NCC Quota)
Ex-Servicemen)
खेल कोटा के िलए दावा (Claim for Sports Quota) No
या आप िवविवालय कमचारी के
वाड ह  (Are you a ward of No
University Employee ?)
संपक योरा वतमान पता (Contact Details Present Address)
पिरसर संया / नाम (Premises
Mahabir Lane Near Idbi Bank े  (Locality) Khandapada Road
No./Name)
उप-मोहला (Sub-
Od-nay-mal-80e-o30 दे श (Country) India
Locality(Optional))
राय/संघ (State/UT) Odisha िज़ला (District) Nayagarh
िपन कोड (Pin Code) 752069 मेल पता (Email Address) Underair62@gmail.com
कं टी कोड (Country Code) +91 मोबाइल नंबर (Mobile Number) 9439491775
वै किपक मोबाइल नंबर (Alternate
9556221988
Mobile Number)
थायी पता (Permanent Address)
पिरसर संया / नाम (Premises
Mahabir Lane Near Idbi Bank े  (Locality) Khandapada Road
No./Name)
उप-मोहला (Sub-
Od-nay-mal-80e-o30 दे श (Country) India
Locality(Optional))
राय/संघ (State/UT) Odisha िज़ला (District) Nayagarh
िपन कोड (Pin Code) 752069
योयता िववरण (Qualification Details)
10वीं योयता िववरण (10th Qualification Details)
पिरणाम िथित (Result Status) Passed उीण वष (Passing of Year) 2022
योयता परीा (Qualifying बोड /िवविवालय का नाम
10th Or Equivalent Central Board Of Secondary Education
Exam) (Board/University Name)
कू ली िशा का थान (Place of कू ल/कॉलेज का कार (Type of School
Urban Government School
Schooling) / College)
योयता परीा दे श (Qualifying Examination Country) India
योयता परीा राय (Qualifying योयता परीा िजला (Qualifying
Odisha Nayagarh
Examination State) Examination District)
कू ल/कॉलेज का नाम पता Odisha Adarsha कू ल/कॉलेज िपनकोड (School/College
752079
(School/College Name Address) Vidayalaya,notar,nayagarh Pincode)
रोल नंबर (Roll Number) 12172050
पिरणाम मोड (Result Mode) Percentage कुल अंक (Total Marks) 500.00
ात अंक(Obtained Marks) 446.00 ितशत % (Percentage %) 89.20
12वीं योयता िववरण (12th Qualification Details)
उीण वष /उपिथित (Passing of
पिरणाम िथित (Result Status) Appearing 2024
Year/Appearing)
योयता परीा (Qualifying बोड /िवविवालय का नाम
12th Or Equivalent Central Board Of Secondary Education
Exam) (Board/University Name)
कू ली िशा का थान (Place of कू ल/कॉलेज का कार (Type of School
Urban Private Unaided
Schooling) / College)
योयता परीा दे श (Qualifying Examination Country) India
योयता परीा राय (Qualifying योयता परीा िजला (Qualifying
Odisha Khordha
Examination State) Examination District)
Mbs Public School,bhouma
कू ल/कॉलेज का नाम पता कू ल/कॉलेज िपनकोड (School/College
Nagar, Bhubaneswar, Odisha 751022
(School/College Name Address) Pincode)
751022
रोल नंबर (Roll Number) NA
िवविवालय/ िवषय चयन (University / Subject Selection)
िवविवालय का नाम िवविवालय काय म का नाम
.सं. (S.No.) िवषय नाम (Subject Names)
(University Name) (University Program Name)
Any One From Section I
B.tech. (information Technology And
1. University Of Delhi +mathematics/applied Mathematics + Section
Mathematical Innovation)
Iii
Physics And Mathematics As Compulsory
Subjects Along With One Of The Following
Subjects: Chemistry, Bio Technology,
B.tech. Computer Science And
2. Central University Of Punjab Biology, Technical Vocational Subject,
Engineering*
Computer Science, Information Technology,
Information Practices, Agriculture,
Engineering Graphics And Business Studies.
Section Ia Languages (any Of The Listed
Babasaheb Bhimrao Ambedkar
3. B.tech. In Computer Engineering Languages May Be Chosen.). Section Ii/iii-
University
Physics/ Chemistry/ Mathematics (all Three)
Shri Mata Vaishno Devi Language Test: English (101) + Physics +
4. B.sc. With Major In Physics
University Mathematics / Chemistry/general Test (501)
Jagannath University, Jaipur English (code 101) Physics (code 322)
5. B.tech -computer Science Engineering
(rajasthan) Mathematics (code 319)
Bachelor Of Technology (aerospace
6. Iimt University Physics, Chemistry And Mathematics
Engineering)
Bachelor Of Technology (computer
7. Iimt University Physics, Chemistry And Mathematics
Science & Engineering)
Physics, Mathematics, English Or Physics,
B.tech (computer Science And
8. Bml Munjal University Mathematics, Chemistry,english/computer
Engineering)
Science / Informatics Practices
Physics, Mathematics And
Hemvati Nandan Bahuguna Chemistry/computer
9. Computer Science And Engineering
Garhwal University Science/electronics/information Technology/
Biology/informatics Practices/ Biotechnology
1. Subject Test – Chemistry (306) 2. Subject
10. Banaras Hindu University B.tech. In Food Technology Test – Mathematics (319) 3. Subject Test –
Physics (322)
5 Year Integrated M.tech In Computer
Physics; Mathematics; And
Mahatma Gandhi Central Science And Engineering (b.tech.
11. Chemistry/biology/computer
University Degree Awarded If Exit After Four
Science/informatic Practices
Years)
12. Central University Of Karnataka B.tech (computer Science) Physics, Chemistry, Mathematics
Chhatrapati Shivaji Maharaj
13. Computer Science Physics, Chemistry And Mathematics
University
I. Physics (code 306)-section Ii Ii. Chemistry
Guru Gobind Singh Indraprastha (code 322)- Section Ii Iii. Mathematics (code
14. B.tech (bt)
University 319)-section Ii Iv. Biology / Biotechnology
(code 304)– Section Ii
B.tech. (lateral Entry) In Mechanical
Engineering, Electrical Engineering,
Dr. Rammanohar Lohia Avadh Physics(322), Chemistry (306) And
15. Electronics Engineering, Civil
University, Ayodhya Mathematics (319)
Engineering, Computer Science
Engineering,information Technology
टे ट पे पर / िवषय चयन (Test Paper / Subject Selection)
टे ट पे पर / िवषय का मायम (Medium of Test
.सं. (S.No.) परीा प (Test Paper) िवषय (Subject)
Paper / Subject)
1 Test Paper 1 Physics English
2 Test Paper 2 Mathematics / Applied Mathematics English
3 Test Paper 3 Chemistry English
4 Test Paper 4 English English
5 Test Paper 5 General Test English
परीा कद और िववरण (Exam Center And Details)
परीा कद के िलए िवकप
.सं. (S.No.) शहर का नाम (राय का नाम) (City Name (State Name))
(Choice For Exam Center)
1 1st Choice For Exam Center Bhubaneswar ( Odisha )
nd
2 2 Choice For Exam Center Cuttack ( Odisha )
3 3rd Choice For Exam Center Puri ( Odisha )
th
4 4 Choice For Exam Center Phulbani (kandhamal) ( Odisha )
उमीदवार ारा अपलोड की गई छिवयां (Images Upload by Candidate)

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शु क भु गतान िववरण (Fee Payment Details)


भु गतान का कार (Payment Mode) Online लेन-दे न आईडी (Transaction ID) CPADRKBTJ8
शु क जमा िकया गया (Fee Submitted
परीा शु क (Exam Fee) 1800 31-03-2024 20:20:51 PM
On)
शु क की पु िट ितिथ (Fee भु गतान गे टवे का नाम (Payment
31-03-2024 20:23:50 PM SBI Epay
Confirmed Date) Gateway Name)
घोषणा (Declaration)
म घोषणा करता हं ू िक आवे दन प म मे रे ारा दी गई जानकारी सभी कार से सय है और कुछ भी िछपाया नहीं गया है । यिद कोई िविट या जानकारी झठ ू ी पाई जाती
है , तो इससे मे रा वे श वत : र हो जाएगा और इसके अलावा म िवविवालय ारा उिचत समझी जाने वाली कारवाई के िलए भी उरदायी हो जाऊंगा। म एतद्ारा
वचन दे ता हं ू िक म ने कायम के िलए ॉपे टस म िनधािरत पाता शतों को यानपूवक पढ़ िलया है । म इस बात से सं तुट होने के बाद आवे दन कर रहा हं ू िक म पाता
शतों को पूरा करता हं ।ू यिद िकसी भी तर पर यह पाया जाता है िक म यूनतम िनधािरत मानदं ड को पूरा नहीं करता हं ,ू तो मे रा वे श, यिद िदया जाता है , र कर िदया
जाएगा और मु झे वे श का कोई अिधकार नहीं होगा। (I declare that information furnished by me in the application form is true in all respect and nothing is
concealed. In case any entry or information is found to be false, this shall entail automatic cancellation of my admission besides rendering me liable to such
actions as deemed fit by the University. I hereby undertake that I have carefully gone through the eligibility conditions prescribed in the prospectus for the
programme. I am applying after satisfying that I meet the eligibility conditions. If at any stage it is found that I do not fullfill the minimum prescribed
criteria, my admission, if granted, shall stand cancelled and I shall have no right to admission whatsoever.)
IP Address : 152.58.149.138 Date of Downloading : 31-03-2024 20:23:51 PM
Domain name : cuetug.ntaonline.in

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