This form should not be submitted to Utkal

University.
Utkal University
P.G Regular Admission for Session
2019-20: Analytical & Applied
NAAC : A+ Economics

For office use only

Date of
Application Id AAE1910427  
Admission

Verifying
Career Mark    
Officer

Entrance Test Dept. Roll

   
Mark No.

Position in
Total Mark    
the List

Head of the Admission

   
Department In-charge

Course: P.G Regular- Subject: MA in Anayitical & Applied

REGULAR Economics

1. Personal Information

Applicant's Name: KANHU SWAIN Gender : Male

KANGRES
Father's Name: Blood Group : O+
SWAIN

Mother's Name: KUNI SWAIN Religion Hinduism

DOB: 16-01-1998 Nationality: Indian

Aadhaar No.: 498127981365 Marital Status: Unmarried

2. Reservation Details

Reservation Category: SEBC Physically Challenged No

Date of Issue of
Sports Person:
Certificate:

Serviceman:

3. Address for Correspondence

AT-KHARIPALLI,PO-SIDHAPUR,VIA-
District: Ganjam
BADAGADA

State Odisha Pincode: 761109

Mobile No: 7735667662 Email Id: kanhuswain7735@gmail.com

4. Permanent Address

AT-KHARIPALLI,PO-SIDHAPUR,VIA-
District: Ganjam
BADAGADA

State: Odisha Pincode: 761109

Would you like to reside in Hostel ? Yes

Whether admitted to any other course ? No

Criminal antecedents/criminal cases: No

5. Payment Details

App Ref. Bank Ref. Date of 2019-05- Rs.

19146238 201914347672424 Amount
No. No. Payment 23 600

Declaration
I do hereby, declare that the particulars furnished in this form are true to the best of my knowledge
and I shall abide by the rules and regulation framed by the university from time to time. I shall forfeit
my seat in case of fraud or misrepresentation on my part.

Date:...................

Scanned Signature of Applicant

Place:..................