Candidate's Details

Application Number : 2021512647

1. Name of the Candidate GAYATHRI N
[As in SSLC or 10th Std Marks Card] * :
2. Name of the Mother *: PARVATHAMMA
3. Name of the Father : NARAYANASWAMY
4. Date of Birth [As in SSLC or 10th Std Marks Card] * : 02/03/2000
5. Gender * : Female
6. Contact Mobile Number * : XXXXXXXXXX
7. E-Mail-Id : XXXXXXXXXXXX@XXXXXXX
8. Marital Status Single Spouse Name

9. Mother Tongue : Kannada Others

10. Native state *: KARNATAKA 10(a). Native District *: KOLAR

11. Annual Income of the family from all 15000 12. Religion * : Hindu
sources * :
13. Nationality * : Indian Status of Other Religion

14. Reservation Category *: Category-2A 14(a). Name of th Caste * : BALAJIGA

14 (b) Income certificate RD Number (RD00-------) RD0038657169080

14 (c) Caste certificate RD Number starting with (RD0--------)
15. Eligibility Clause Code * : a

Course Details
16. Admission To * : Day Engg College
17. Exam Place 1 where you wish to appear for Diploma CET 2021 * : KOLAR
18. Diploma register number * : 131CS18009
17 A. Exam Place 2 where you wish to appear for Diploma CET 2021 * BENGALURU

19. Diploma Course Holder in : Computer Science and Engineering

20.a Dcet Examination Subject*: CS - COMPUTER SCIENCE ENGINEERING

20. Have you appeared for NATA Exam? No

Study Information
21. Total number of completed years of study in Karnataka * : 13
22. Have you Studied in Rural Area from 1st standard to 10th standard ? No
23. Have you Studied in Kannada Medium from 1st standard to 10th standard ? No
24. Are you claiming reservation under Article 371 ( j ) Hyderabad-Karnataka ? No
24 (a) 371(J) RD Number starting with (RD0--------)

25. Candidate's Postal Address for Communication

Full Address * : KESARANAHALLI VILLAGE, ROBETSONPET HOBLI, BANGARPET TALUK, BANGARAPET, KOLAR,
KARNATAKA - 563162
26. Special Category :
Type of Disability

Study Details
27. Do you possess a certificate of Diploma or Equivalent Examination ? * No
28. Are you Awaiting for any Diploma results or Equivalent Examination ? * Yes
29. Name and Place of the Board / University : BOARD OF TECHNICAL EDUCATION,
BANGALORE
Status of other Place of the Board / University :

30. Name of the College * : SCHOOL OF MINES KGF

31. College Address : KORAMANDAL KGF
32. Is your qualification marks card issued in grade points ? * No
State of Birth KARNATAKA

Candidate Place of Birth KESARANHALLI

Printed Date: 05:11:2021 02:58:21

 Year Status of Result Month of Year of Max. Total Marks
Passing Passing Marks Obtained
1 Pass APRIL 2019 1200 833
2 Pass APRIL 2019 1200 1086
3 RAP SEPTEMBER 2021 0 0

Declaration

I declare that the information furnished through online is true and correct to the best of my knowledge and belief. I have read the
Instructions carefully hosted on the KEA website "Information Bulletin for Filling up of Online Application". In case any of the
information furnished online by me is found to be false or incorrect, I shall forfeit the claim to be considered or a seat selected
and allotted by KEA. I am liable for civil and criminal action, that the State Government or the KEA may take against me in this
regard.

Signature of the Candidate Left Hand Thumb impression of Date: 09:09:2021 12:50:14
the Candidate
Payment Status
Application Fees: 650 Bank Name: RTGS/NEFT Payments from any Bank
Account to HDFC bank
Bank Charges: 0 Bank Ref Number: IBKL210914813314
Total Amount: 650 Date of Payment: 14-09-2021

Details of reservation claimed by the candidate

Clause Code a Name of the Caste BALAJIGA

Rural No Reservation Category Category-2A

Kannada No Article 371(J) Hyderabad Karnataka No

Special Category :

Type of Disability
Note (For Evening Engg College): candidate after obtaining the diploma, must have minimum of Two Years Full Time Work experience in
a registered firm / Company / Industry / Educational and / Government Autonomous Organizations in the relevant field in which admission
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Printed Date: 05:11:2021 02:58:21