ODISHA UNIVERSITY OF AGRICULTURE & TECHNOLOGY

APPLICATION FORM-A
FOR ADMISSION INTO UNDER GRADUATE COURSES - 2020

Applicant Details

Applicant Name KIRTIRANJAN JENA Application No. ACK01030536

UIDAI Type Aadhaar Number UIDAI Number 979306527970

Mother's Name TARULATA JENA Father's Name KISHORE CHANDRA JENA

Date of Birth 01/03/2003 (Age as on 31.12.2020) 17 Years 9 Months 30 Days

Gender Male Religion Hindu

Blood Group A+ Parents Annual Income 1 Lakhs to 3 Lakhs

Category UR Mother Tongue Odia

Nationality INDIAN Email jenakishorchandra0@gmail.com

Mobile Number 9437216674 Alt. Mobile No. 8895350747

Present Address Permanent Address

C/O- KISHORE CHANDRA JENA AT- HALADIBASANTA C/O- KISHORE CHANDRA JENA AT- HALADIBASANTA
Address Address
PO- DHARA PUR PS- BARI RAMACHANDRAPUR PO- DHARA PUR PS- BARI RAMACHANDRAPUR
District Jajpur District Jajpur

State Odisha State Odisha

Country India Country India

Zip Zip
755003 755003
Code Code

Domicile Information
Has the Candidate passed Odia as one of the Subject in HSC entrance Exam from any School/Institute of Odisha? Yes

Ability to read, write and speak Odia language Read , Write , Speak

Choice of Center
First Choice Jajpur Second Choice Cuttack Third Choice Bhubaneswar

Payment Details

Payment Date Reference No. Receipt No. Amount (₹) Status

19/04/2020 TXOUA190420200045225 RTOUA190420200034511 1400.00 Payment Made Successfully.

Declaration

I, KIRTIRANJAN JENA do hereby declare that the information submitted by me in the application is true to the best of my knowledge and belief. I
have applied for OUAT UG admission 2020 with the consent of my Parents and Guardians.