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Candidate's Details
Application Number : 106429
1 Course/s Applied for PGCET : M B A (only)FullTime

2 Name of the Candidate : DARSHAN RAO N

3 Name of the Father : NAGARAJA RAO N
4 Name of the Mother : MANJULA
5 Date of Birth : 22:10:1999
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 200000
income also)
10 Category : Category-3B 10 a. Sub-Caste : MARATA
Income RD Number (RD00-------) RD3038245014114
Caste RD Number starting with (RD0--------)

11 Religion : Hindu
12 Eligibility Clause Code: a
13 Qualifying Degree / Engineering Branch ? B.Com (3 Years Degree)

Study Information
Qualifying Degree Status ? Appeard University Seat No : (USN) C7110011
Qualifying Degree College Name : JANATHA GOVT FIRST Qualifying Degree University DAVANGERE UNIVERSITY
GRADE COLLEGE Name :
Total Number of Years of Study in Karnataka : 15
Particulars of Result Month of Passing Year of Passing Maximum Marks Secured Marks
Examination
1 Pass May 2018 1500 775

2 Pass November 2019 1500 928

3 Awaiting November 2020 800 522

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--------)

M.Tech Program Details (Only for M.tech Candidates)

PGCET Appearing under :

PGCET Exam Appearing Course Name :

Have you Appeared for GATE during 2018 to 2020 ?

GATE Code :

GATE Score : 0

Do You Claim Seat under Sponsered Quota?

17. PGCET Examination Centre 1 DAVANGERE

17.(a) PGCET Examination Centre 2 DAVANGERE

17.(a) PGCET Examination Centre 2 SHIMOGA (SHIVAMOGGA)

Candidate's Postal Address for Communication
Address : DARSHAN RAO N SON OF NAGARAJA RAO N,KANIVEBILACHI VILLAGE AND POST,CHANNAGIRI
TALUKCHANNAGIRI,DAVANGERE ,KARNATAKA-577231
Mobile No : XXXXXXXXXX
Email : XXXXXXXXXX@XXXXXXXX

Declaration
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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 same.If 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 : 106429 NAME OF THE CANDIDATE : DARSHAN RAO N
APPLICATION FEES : 650 BANK NAME : NEFT/RTGS/IMPS Payments from
any Bank Account to Corporation
Bank
BANK CHARGES : 0 BANK Ref NUMBER : 1190927234

Printed Date 07-10-2020 09-27-20