Scribd
Upload
10 views2 pages

PGCET 2019 Candidate Application Details

This document contains the application details of Sample, who is applying for the M.Tech/M Arch program. It includes personal details like name, date of birth, gender, family income, religion, eligibility details, educational qualifications, exam details, address and declaration. Sample has completed a B.E in Computer Science Engineering from DEGREE college under VITU university with a total of 12 years of study in Karnataka. They are applying under the general merit quota and have not claimed any reservation.

Uploaded by

Ankit Yadav
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
10 views2 pages

PGCET 2019 Candidate Application Details

This document contains the application details of Sample, who is applying for the M.Tech/M Arch program. It includes personal details like name, date of birth, gender, family income, religion, eligibility details, educational qualifications, exam details, address and declaration. Sample has completed a B.E in Computer Science Engineering from DEGREE college under VITU university with a total of 12 years of study in Karnataka. They are applying under the general merit quota and have not claimed any reservation.

Uploaded by

Ankit Yadav
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Candidate's Details

Application Number : 555555


1 Course/s Applied for PGCET : [Link]/M Arch (only)FullTime
CANDIDATE'S PHOTO
2 Name of the Candidate : SAMPLE
3 Name of the Father : FATHER
4 Name of the Mother : MOTHER
5 Date of Birth : 22:02:2000
6 Gender : Male 7 Quota : Karnataka
8. Marital Status Single Spouse Name

9. Annual Income of the family from All Sources (If married include your spouse 1000000
income also)
10 Category : General Merit 10 a. Sub-Caste : SUBCASTE
Income RD Number (RD00-------)
Caste RD Number starting with (RD0--------)

11 Religion : Hindu
12 Eligibility Clause Code: a
13 Qualifying Degree / Engineering Branch ? B.E - COMPUTER SCIENCE ENGG

Study Information
Have You done BCA, BSc (I.T / Computer Science ) with Mathmatics at 10+2 level or at Yes
Graduate Level ? (for Lateral entry to 2nd Year MCA )
Qualifying Degree Status ? Completed University Seat No : (USN) 12345
Qualifying Degree College Name : DEGREE Qualifying Degree University VITU
Name :
Total Number of Years of Study in Karnataka : 12
Particulars of Result Month of Passing Year of Passing Maximum Marks Secured Marks
Examination
1 Pass April 2015 500 450

2 Pass April 2016 500 450

3 Pass April 2017 500 450

4 Pass April 2018 500 450

5 Pass April 2019 500 450

14 Do You Claim Reservation Under Physically Disabled Quota ? No


15 Do You Claim Reservation Under Ex-Serviceman Quota ? No
16 Do You Claim Reservation Under 371(J) (Hyderabad Karnataka) Quota ? No
16 (a) 371(J) RD Number starting with (RD0--------)

[Link] Program Details (Only for [Link] Candidates)


PGCET Appearing under : TYPE A

PGCET Exam Appearing Course Name : Computer Science Eng


Have you Appeared for GATE during 2018 or 2019 ? No

GATE Code :

GATE Score : 0

Do You Claim Seat under Sponsered Quota? No

17. PGCET Examination Centre BELGAUM (BELAGAVI)

Candidate's Postal Address for Communication


Address : 12345,BANGALORE,HOSKOTE,BANGALORE URBAN (BENGALURU),KARNATAKA-123456
Mobile No : 9999999999
Email : email@[Link]

Declaration
I declare that the above information is true and correct to the best of my knowledge and belief. I have gone through the
relevant Government Orders, Admission Rules and all Notifications / Website Notification issued by competent Authorityfor
PGCET-2019 and understand the [Link] any of the information furnished above is found to be false or incorrect, I shall
automatically forfeit my claim to be considered for a seat or the seat already been opted by me in a Professional College in
Karnataka. In such event, I will also liable for such civil and criminal action as the State Government / KEA may take against me
in this regard.

Signature of the Left Hand Thumb impression of Date:


Candidate the Candidate

Principal / Gazetted Officer Signature


Name:
Signature:

Seal:

PAYMENT STATUS
Appno : NAME OF THE CANDIDATE :
APPLICATION FEES : BANK NAME :
BANK CHARGES : BANK Ref NUMBER :

Printed Date

You might also like