Professional Documents
Culture Documents
[3f3ed7972881789400a75f80b7df70fb]
I.Student Information
4ĝc2lÍApplication Number 114600
4YÍħ[²lc\h MANOJ S K
Q2¡l[²lc\h KRISHNA S V
eĵ[²lc\h SRIDEVI K S
I . 5. Ĺ2DGender : Male
I . 8. 6ijsşĻecE-Mail-Id : manojXXX
II . 2. TZReligion : Hindu
II . 3¨eQj§e°l
ci´şe¬lsŊªleŏVÎe\ KANNADA
Mother Tongue
II. 4. Īs`<Ť<Ť<şľ£lsQ\DĦ[UhÇB£eLBSĹЮeÍc2D¨eģĨÅsªe! Yes
Have you studied SSLC/10th standard in Karnataka?
II . 5Īs`B£eLBSĹÐ12£ls¦lisŏVĸsďl[UhÇXªlĨĨÅsªeeĥľli2ģĨÅsªe Yes
Xªl[hĦÃĨÅsªe!
Did you write/appearing/attending Board Exam of 12th in Karnataka?
II. 6B£eLBSĹÐ
1ĸ2S12£lsQ\DĦ`ªll®eÍc2D¨eģlsDl²li2ĨSVP 12
`bD_
Total number of completed years of study in Karnataka (From 1st to 12th Std.)
II. 7Īs`¢eIJB4^Èc2eÍQIJsc¬eĦX[chĦÃsªe! No
Are you claiming Religious Minority Quota ?
®ltSÍĔs[ZQhÃS2Q®ltSÍĔs[lisŤDĺl¨eQÎZhľÐ2ZQhÃĔÎļ¹[Ŗ
only for medical and dental courses (Muslim /Christian)
®ltSÍĔs[ZQhÃS2Q®ltSÍĔs[lisŤDĺl¨eQÎ
only for medical and dental courses (Tulu/Tamil/Telugu/Kodava)
6ShĪs`UZiĨľ\h`¨eQj§e°lB£eLBSĹЮeÍc2D¨eģS`bD_
104R®e12
£lsQ\DĦ[¦lisŏVĸsďl²eDieÐŤlisŏijs¬l4`^2İQ®eĖ\hQál
Note : It depends on Mother Tounge ,Number of years study in Karnataka ,
Board Exam of 10th/12th/Both in Karnataka. and clause code 'a'
II . 9. eĦ[²lc\hName of the Caste : KURUHINASHETTY
Select the preference place three you wish to appear for CET-2020
III . ®eÍc2DĻ`\D_
£lsQ\DĦĵ2Sī[hľ£lsQ\DĦ4deVĸsďl[`ªll
STUDY DETAILS : From 1st standard to II PUC / 12th standard / Qualifying Examination
ci´şe¬lsĝUĻecZQhÃSi\®eĥc2lÍ ®eÍc2DS ®eÍc2DS ®eÍc2DS lsDl©eS
Complete Name & Address of the School / College with Q\DĦD_
¤eÎ\2ıB`b li£l[`b `b
Telephone Number
Classes Year of study Year of Year of
Studied From study To Passing
75Ŗ¬ltŖZhe2Q\Īsģ\h`<¬eвlsĺlD_
¨eĿĦD_
UZlĦĺSZġ¾lcQͲeDhĪC\®l2Sh7Zi^B
ęisĽchlÃs®l75Ŗ¬ltŖ4ĝQh2Xh`Sl´c2X2ĩľS2l¨eĿĦltīģ[ĹвeDhl6<®lř±ltōUĹÐĪsģ\h`<¬eÐ
¨eĿĦciG£lD_UhÇQh2¦e<G¹ĸlĵ2S@Ĩ\hlÃs®l?2Sh®lsl£e`5Ŗ¬ltŖZhe2Q\Īsģ\h`©e`¡ls¨eĿĦ[h
QVÈ4R®e4cQÍ®l2ShB2NhX2SĹÐB£eLBVĸsďe¤eÎĩe\`7c2X2TUZÌĻ\hSÆllShli_ÑXdh¡eSeUiUh
ĸsĦ[BÎZDĺlXSÆ£eĖ\hlÃs®l
We declare that the information furnished through online is true and correct to the best of our knowledge and belief.
We 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 us is found to be false or incorrect, We are also
liable for action, that the State Government or the KEA may take against us in this regard.
ah^´c2¡e[Ļ`\Payment Status
4ĝah^´ 500 ¦eÍ2Ń²lc\h online INB
Application Fees : Bank Name :
¦eÍ2Ńc2lÍ RUP2850949980 ah^´c2¡e[Ĩ£e2B 10-02-2020
0
Bank Ref No : Date of Payment:
¤eÎ2ah¤e^\Dllŏ5ĬscŝcĿPrincipal / Gazetted Officer Signature
²lc\hName :
VPcĿSignature :
ūd\hSeal:
DZĪľ1<¬eÐVÎĔÎĶVPli2NU2Q\4YÍħ[h42ĦZVÎĦ[UhÇZhĨÎľli2Nh¡eC¬l
eBhÍij2ōVĸļs^£lc2SYSĹÐ
BeÀ[®eĖcĹÐc¦lsBh
2ľsLhd2ělVÎĔÎĶ[cZ[SĹÐ?SĖch`eĦZQhÃ5¡e[VΨePVQÎ`5Ŗ¬ltŖ4ĝ[cZ[SĹÐUZiĨľSeĦZQhÃ
5¡e[`BeÀ[®eĖ?2¡ls5Ė\¦lsBh42ĦZęisbl[U2Q\©e`¡lse\PBi´eĦ[ĹÐXS¬e`ll4`eaĻ\h`Ĩ^Ð
NOTE : 1. After completion of all the process the candidates are required to take final print out of the Online Application Form
and submit the same during Document Verification.
2. The CASTE and INCOME certificate to be produced by candidates during seat selection process should have the
same CASTE and INCOME, as mentioned in this Application Form. No change in Caste / Category will be permitted
after the final declaration.
Details of reservation claimed by the candidate
Clause Code a Name of the Caste KURUHINASHETTY