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BTech Application Details for Omkar Gurav

This document contains an application for admission to a BTech course. It includes details such as the applicant's name (Omkar Sunil Gurav), address, date of birth, gender, nationality, course details, payment details including a DD number and date, and declarations signed by the applicant agreeing to abide by admission provisions and confirming that application details are true.

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Omkar Gurav
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6 views1 page

BTech Application Details for Omkar Gurav

This document contains an application for admission to a BTech course. It includes details such as the applicant's name (Omkar Sunil Gurav), address, date of birth, gender, nationality, course details, payment details including a DD number and date, and declarations signed by the applicant agreeing to abide by admission provisions and confirming that application details are true.

Uploaded by

Omkar Gurav
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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APPLICATION NUMBER 3136608 PAYMENT MODE DD

COURSE GROUP 2 AMOUNT 2000


COURESES/APPLIED [BTech] DD NUMBER 559601
TEST CENTER Bangalore,Belgaum DD DATE 02/4/2018
DATE OF BIRTH 03/4/2000 CATEGORY GENERAL
SEX Male NATIONALITY India
NAME OF THE APPLICANT OMKAR SUNIL GURAV
NAME OF THE PARENT/ SUNIL GURAV
GUARDIAN
ADDRESS LINE 1 72/1
ADDRESS LINE 2 hindu nagar
ADDRESS LINE 3 tilakwadi belgaum
PIN 590006 STD CODE/TELEPHONE NA
NUMBERS
CITY Belgaum E-MAIL ADDRESS omkargurav974@gmail.
com
STATE Karnataka MOBILE NUMBER +917204987956
DATE OF COMPLETION OF NA
INTERNSHIP
EXAM REG NUMBER NA EXAM ROLL NUMBER NA
EXAM NAME NA EXAM SCORE NA
EXAM RANK NA
FOR MD/MS FOR MTECH
APPLICANTS APPLICANTS
ARE YOU A DIPLOMA NA ARE YOU A GATE SCORER? NO
HOLDER?

DECLARATIONS:
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I
have read and understood all provisions of admissions and agree to abide by them. I also affirm that I fulfil the eligibility
requirements for the course/s applied. In the event of submission of fraudulent, incorrect or untrue information or
suppression or distortion of any fact, like educational qualification, marks, nationality etc. I understand that my admission/
degree is liable for cancellation. I further understand that my admission is purely provisional subject to the verification of the
eligibility conditions.
NOTE:
[Link] keep a copy of the filled in application for future reference.
[Link] number must be quoted in all future correspondence.
[Link] candidates who are appearing for GATE exam should submit the valid score card on or before the last
date of receipt of application (For MTech / MSc Tech applicants only)
[Link] send this completed application form with DD/Challan(if payment is not via Credit Card) to: Director -
Admissions, Manipal Academy of Higher Education, Manipal - 576104

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