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637797701220299390

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ADMISSIONS 2022

APPLICATION FORM
Personal details
Registration number 122274
Course name B.Tech
Name of the applicant MOHIT SHERKHANE
Gender Male

Date of birth 11-Oct-2004


Blood group A-Positive
Nationality Indian
Religion Hindu
Category SC
Caste SCHEDULE CASTE (S.C) - DHOR
Mother tongue KANNADA
Citizenship Indian

Family size Self +


2
Place of birth VIJAYAPURA
Handicapped No
Phone no 0836-2740201
Mobile no 9844941555
Email ID mohitshers@gmail.com

Details of address Permanent address Communication details


Parent/Guardian's name DR MAYUR SHERKHANE DR MAYUR SHERKHANE
KESARINANDAN BUILDING, MALAPUR KESARINANDAN BUILDING, MALAPUR
Address MAIN ROAD, MAIN ROAD,
NEAR RAMANGOUDAR HOSPITAL, NEAR RAMANGOUDAR HOSPITAL,
City DHARWAD DHARWAD
State Karnataka Karnataka
Pincode 580008 580008

Details of parents Father Mother


Name DR MAYUR SHERKHANE DR RADHIKA SHERKHANE
Qualification MBBS , MD MBBS , MD
Occupation DOCTOR DOCTOR
Designation PROFESSOR PROFESSOR
SDM COLLEGE OF MEDICAL SCIENCES SDM COLLEGE OF MEDICAL SCIENCES
Employer details
AND HOSPITAL, DHARWAD, KARNATAKA AND HOSPITAL, DHARWAD, KARNATAKA
Annual income 884000 884000
Alumnus of PES No No

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Details of qualifying examination


JSS R S HUKKERIKAR P U ARTS, COMMERCE AND SCIENCE COLLEGE,
Last institute studied name   
VIDYAGIRI, DHARWAD
Last institute studied Address BEHIND JSS BANASHANKARI ARTS AND COMMERCE COLLEGE
, VIDYAGIRI, DHARWAD

City : DHARWAD,  State : Karnataka,  Pincode : 580004

Last institute left (on or expected) 2022 Qualifying examination 12th State Board

Details of branch
Branch being sought Preference  1 :  Computer Science Engineering
Preference  2 :  Electronics & Communications Engineering
Preference  3 :  Artificial Intelligence & Machine Learning

Test centre preferences


1.  Hubli     2.  Belgaum     3.  Bangalore

Other details
Residence Resident of Karnataka (KAR)
Admission through PESSAT

Payment type online payment


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