GOVERNMENT OF BIHAR

Bihar Combined Entrance Competitive Examination Board

Online Application Form for Bihar Combined Entrance Competitive Examination (BCECE) - 2021
for admission to First Year Degree Courses
Registration No. 2210003380 Please donot send this Hard Copy to BCECE Board
PART- A
1. Course Group Applied For : PCB

2. Name of Candidate : VIVEK KUMAR

3. Father's Name : SURENDRA CHOUDHARY

4. Mother's Name : BASANTI DEVI

5. Date of Birth: : 08/ November /2000

6. Gender : Male

7: Reservation Category : SC (Schedule Caste)

8. Disabled Quota : No

9. Mobile No. : 880****105 Note: Please Affix your same photo and put your full
signature in English and Hindi in spaces provided above.

10. Aadhaar Card No : 971*********998

11. Email ID : viku8877999@gmail.com

12. Marks of identification : RIGHT HAND SHOULDER MOLE
13. Are You Permanent Resident of Bihar? : Yes
14. Residential Eligibility
:
15. Are you unable to write due to permanent loss of limbs / suffering from : N/A
Cerebral palsy :
16. District Name of the Institute of passing/appearing at I.Sc or equivalent : PATNA
17. Family Annual Income : N/A
18. Do you claim for Economically Weaker Sections (EWS) ? : N/A
19. Do you claim SMQ Quota : No
20. Are you Son/Unmarried Daughter of Military Personnel? : N/A
21. Percentage of marks obtained in qualifying examination, if Passed:
( Physics+ Chemistry+ Biology): 57.67% (English): 72.00%
22. Payment Details:

Payment Mode Journal No. / Transaction No. Deposit Date Amount (in Rs.)
ONLINE BCE611dd1bc8f00c 2021-08-19 09:09:13 Rs. Five Hundred
23. Address Details:
A. Permanent Address: B. Correspondence Address:
Old Jakkanpur, Manjhusa Gali Near POWER Gird Old Jakkanpur, Manjhusa Gali Near POWER Gird
Patna Patna
gardanibagh gardanibagh
District: PATNA District: PATNA
State: Bihar Pin Code: 800001 State: Bihar Pin Code: 800001
Declaration by the Candidate: I VIVEK KUMAR declare that the informations furnished above are correct and I shall forfeit my candidature
and will be liable for legal action in case of any of them is proved to be false at any stage inclusive of admission or thereafter.

Date: .................
Place: ................... (Signature in English) (Signature in Hindi)

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 GOVERNMENT OF BIHAR
Bihar Combined Entrance Competitive Examination Board
Online Application Form for Bihar Combined Entrance Competitive Examination (BCECE) - 2021
for admission to First Year Degree Courses
Registration No. 2210003380 Please donot send this Hard Copy to BCECE Board
PART- B
(For office use only)
Select for admission(First Counseling) Select for admission(Second Counseling) Select for admission(Third Counselling)

Against Roll No............................................... Against Roll No............................................... Against Roll No...............................................

Reservation Category.................................... Reservation Category.................................... Reservation Category....................................

Merit Serial .................................................. Merit Serial ................................................. Merit Serial ..................................................

at....................................................(institution) at....................................................(institution) at....................................................(institution)

in...................................... (Course/Branch) in...................................... (Course/Branch) in...................................... (Course/Branch)

Signature of Signature of Controller of Signature of Signature of Controller of Signature of Signature of Controller of

the Candidate the verifying Examination the Candidate the verifying Examination the Candidate the verifying Examination
(At the time of Officer BCECEB (At the time of Officer BCECEB (At the time of Officer BCECEB
Counseling) BCECE-2021 Counseling) BCECE-2021 Counseling) BCECE-2021
Date: Date: Date:

1. Course Group Applied For : PCB

2. Name of Candidate : VIVEK KUMAR

3. Father's Name : SURENDRA CHOUDHARY

4. Mother's Name : BASANTI DEVI

5. Date of Birth: : 08/ November /2000

6. Gender : Male

7. Reservation Category : SC (Schedule Caste)

8. Disable Quota : No

24. Mobile No. : 880****105

Note: Please Affix your same photo and put your full signature
25. Aadhaar Card No : 971*********998 in English and Hindi in spaces provided above.

9. Email ID : viku8877999@gmail.com

10. Marks of identification : RIGHT HAND SHOULDER MOLE

11. Are You Permanent Resident of Bihar? : Yes
12. Residential Eligibility
:
13. Are you unable to write due to permanent loss of limbs / suffering from : N/A
Cerebral palsy :
14. District Name of the Institute of passing/appearing at I.Sc or equivalent : PATNA
15. Family Annual Income : N/A
16. Do you claim for Economically Weaker Sections (EWS) ? : N/A
17. Do you claim SMQ Quota : No
18. Are you Son/Unmarried Daughter of Military Personnel? : N/A
19. Percentage of marks obtained in qualifying examination, if Passed:
( Physics+ Chemistry+ Biology): 57.67% (English): 72.00%
20. Address Details:

Registration No:2210003380 Printed On: 19-08-2021 09:15:24 Page: 1/3

 A. Permanent Address: B. Correspondence Address:
Old Jakkanpur, Manjhusa Gali Near POWER Gird Old Jakkanpur, Manjhusa Gali Near POWER Gird
Patna Patna
gardanibagh gardanibagh
District: PATNA District: PATNA
State: Bihar Pin Code: 800001 State: Bihar Pin Code: 800001
21. Educational Qualification:

Level School/College Name Board/ University Name Passing Status Passing Year
Secondary/Standard DOON PUB SCHOOL INDIRA NGR Central Board of Secondary
Passed 2015
X POSTAL PARK Education
I.S.C./XII (10+2) A N COLLEGE Bihar School Examination Board Passed 2017
(Submit Marksheet of Matriculation and I.Sc. if passed)

22. Marks Details:

% of Marks % of Marks % of Marks
Subject in I.Sc/10+2 % of Marks obtained in
S.N. Marks Obtained Total Marks obtained in obtained in obtained in
Exam CBA/PCA/MBA/MCA
English PCM PCB
1 English 72 100
2 Physics 51 100
72.00% N/A 57.67% N/A
3 Chemistry 57 100
4 Biology 65 100

23. Declaration of the Candidate:

I, VIVEK KUMAR Son/ Daughter of SURENDRA CHOUDHARY hereby solemnly and sincerely affirm the statements made and information
furnished above by me and in the enclosures hereby submitted by me are true and correct. I have not kept my information secret. If, however, it
is found that any information furnished therein is fraudulent, incorrect or untrue in materials/particulars, I realize that I am liable criminal
prosecution and agree to forego my seat in the college and further that the selection and admission to this course is liable to be canceled. I
agree to abide by the rules and regulations governing this Examination and as contained in the prospectus of BCECE - 2021 .

Repeat below in your handwriting (not in capital letters) the above mentioned Declaration and put your signature in English and Hindi
at the specified spaces as signed in Part A of the Online Application Form. If you fail to do so, your Candidature shall be rejected:

...............................................................................................................................................................................................................................

...............................................................................................................................................................................................................................

...............................................................................................................................................................................................................................

...............................................................................................................................................................................................................................

...............................................................................................................................................................................................................................

...............................................................................................................................................................................................................................

Place: Full Signature (in Hindi) ..................................

Date: Full Signature (in English) ..................................

Counter Signature of Father/Mother/Husband/Guardian ..................................

24. List of Enclosure:

1.
2.
3.
4.
5.
6.
7.
8.

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 25.
(AT THE TIME OF FIRST COUNSELLING/INTERVIEW ONLY)
(I) Full signature of the candidate (ii) L.T.I of the Candidate
(English)

(Hindi)

(AT THE TIME OF SECOND COUNSELLING/INTERVIEW ONLY)

(I) Full signature of the candidate (ii) L.T.I of the Candidate
(English)

(Hindi)

(AT THE TIME OF THIRD COUNSELLING/INTERVIEW ONLY)

(I) Full signature of the candidate (ii) L.T.I of the Candidate
(English)

(Hindi)

26.
(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF FIRST COUNSELLING)

Roll No. ........................................ Reservation Category .................................... Merit Serial ............... of BCECE- 2021 in the

First Year of ........... Branch/Course of the Institute ................................................ as He/She fulfilled all the requirements of being

admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE

DIRECTOR/PRINCIPAL

(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF SECOND COUNSELLING)

Roll No. ........................................ Reservation Category .................................. Merit Serial ............... of BCECE- 2021 in the First

Year of .......... Branch/Course of the Institute ................................................ as He/She fulfilled all the requirements of being

admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE

PRINCIPAL/SUPERINTENDENT

(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF THIRD COUNSELLING)

Roll No........................................ Reservation Category .................................. Merit Serial ............... of BCECE- 2021 in the First

Year of ............ Branch/Course of the Institute ................................................ as He/She fulfilled all the requirements of being

admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE

PRINCIPAL/SUPERINTENDENT

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