MJBC-5070039243

Mahatma Jyothiba Phule BC Welfare Residential Educational Institutions

Society, BACKLOG CET
Admission Test for 6th Class (2023-24)

Personal Details
1 Reference Id : 5070039243
2 Surname : AMPOLU
3 Candidate Name : AMPOLU CHARAN
4 Father's Name : AMPOLU BHASKARARAO
5 Mother's Name : AMPOLU CHANDRAKALA
6 Date of birth : 13/10/2011
7 Gender : Male
8 Address : FLAT NO - 202 SAI BABA ROAD
NCL NORTH AVUNE KOMPALLY
HYDERABAD
Mandal : QUTHBULLAPUR
District : MEDCHAL(MALKAJGIRI)
Pincode: 500067
9 e-Mail : ampoluchandrakala5@gmail.com
10 Mobile : 9390530265
11 Alternate Mobile : 8008604449
12 Reservation Category : OC/EBC
13 Are you an Orphan : No
14 Whether the Annual Income of Parent is Yes
below Rs.1,50,000(rural) or 2,00,000(urban) :
Examination Center Details
15 Medium in which candidate desires to appear ENGLISH
for the Test:
16 Examination Center/District at which MEDCHAL(MALKAJGIRI)
Candidate desires to appear for the Test :
17. Education Details
S. No Year Of Study Class in which Medium of study District in which Select whether the
Studied/Studying school of study is School is
located (Govt./Govt Aided/
Govt Recognized)
1. 2021-2022 4th ENGLISH MEDCHAL(MALKA Govt Recognized
JGIRI)
2. 2022-2023 5th ENGLISH MEDCHAL(MALKA Govt Recognized
JGIRI)
18.Payment Details
Fee Amount Journal Number Payment Date
100 /- YUR31837547048 12/04/2023
I hereby declare that
I read the information bulletin of Admission Test for 6th (2023-24) and found myself fully eligible to appear for
the entrance test as per the criteria mentioned in the Information Bulletin.
The information furnished above is true and to the best of my knowledge. I will produce the original as and when
asked by the Department at the time of Admission. I am aware that any wrong information furnished by me disqualifies
my selection automatically.
Sd/-
AMPOLU CHARAN

12/04/2023 02:30:52 PM
5070039243