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ApplicationNo:16009575

NameoftheCandidate

CHENNUBOINALOKNADH

DateofBirth
(AsinSSC/10th)(ddmmyyyy)

03021990

Gender

Religion

Hindu

Nationality

Indian

CasteCategory

OBC/BC

MotherTongue

16

State

02

BloodGroup

O+

CommunicationAddress

CHENNUBOINALOKNADH,
D.NO2516116/1PARVATHIPURAM,
1STLINESAMPATHNAGAR,
GUNTUR,
GUNTUR,
ANDHRAPRADESH,
IN,
PinCode:522004.

PhoneNo.withSTDcode

MobileNo:9885511367

EmailAddress

ch.loknadh@gmail.com

NameoftheParent/Guardian

CHDURGAPRASAD

RelationshipwiththeCandidate

Father

Parent's/Guardian'sOccupation

PrivateService

AnnualIncomeof
Parent/Guardian

3to5lac

Sports

None

NCCCertificate

None

Cultural

None

ProgramApplyingfor

ParttimePh.D
Choice1
51

ChoiceofBranch

Choice2

Choice3

TestCity(Manual)
TestCity(Online)
HostelAccommodationRequired

QualifyingExam
Passed/Appearing
2013

Reg.No./Roll
Number(ifalready
Allotted)
Y11MTEC804

QualifyingExamStatus

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NameandCompleteAddressofthe
School/Collegefromwhere
passed/appearing
RVR&JCCOLLEGEOFENGINEERING

MonthandYearof
Passing/Appearing
SEP2013

Passed

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AcademicRecord

ClassX
Agg.Marks(%)

83

YearofPassing

2005

ClassXII
Agg.Marks(%)

86

YearofPassing

2007

Board

StateBoard

MediumofStudy

English

UnderGraduation
QualificationCode

13

ModeofStudy

Regular

CourseDuration

4Years

Status

Completed

Agg.Marks(%),IfCompleted

64

Agg.Marks(%),IfStudying
YearofPassing

2011

PostGraduation
QualificationCode

13

ModeofStudy

Regular

CourseDuration

2Years

Agg.Marks(%),IfCompleted

77

Agg.Marks(%),IfStudying
YearofPassing

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2013

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Declaration
"IherebydeclarethatIhavecarefullyreadtheinstructionsanduderstoodtheparticularssuppliedtomeandthatthe
entoresmadeinthisapplicationformaretrueandcorrecttothebestofmyknowledgeandbelief.Iunderstandthat
the decision of the University id final with regard to selection for admission. If selected fro admission, I promise to
abide by the rules and regulations of the Univesrity as existing and as would be amended from time to time. The
UniversityshallhavetherightroexpelmefromtheUniversityatanytimeafteradmission,provideditissatisfiedthat
iwasadmittedonfalseparticularsfurnishedbymeormyantecedentsprovingthatmycontinuanceintheUniversity
isnotdesirable.Feespaidoncewillnotbeclaimedbackunderanycircumstances.Iagreethatalldisputesarsubject
tothejurisdictionofthecourtsatVijayawadaOnly".
Place:

Date:
Signatureoftheapplicant

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SignatureofParent/Guardian

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