Online Edit Application Form - BSc Nursing,BPT,BPO,BSc AHS Courses - 2021

Application Number 512386

Courses Applied BSC Nursing ,

4YÍħ[²lc\h
Candidate Name ) SUSHMITHA V

Ÿeĵ[²lc\h
Mother's Name ) LAKSHMI

Q2¡l[²lc\h
Father's Name ) VANKATESH H

dhġ¾SĨ£e2B(Date of birth) 07/01/2003

Ĺ2D(Gender) Female

4YÍħ[c2VBSū¦ltşc2‘lÍ 7676546716 6ijsşĻ­ecE-Mail-Id : hvenkatesh450@gmail.com

Candidate's Contact Mobile Number
:

4YÍħ[c2VBS42•lĻ­ecCandidate's Postal Address for Communication

Ļ­ec CO VENKATESH H INGALADALU LAMBANIHATTI CHITRADURGA

Address :
įsŖU2Xŝ 0
Phone Number :
īŖlisŏ 577524 ªeIÍState KARNATAKA
Pin code
ªeĽĄs[Ÿl Indian
Nationality

Reservation Details
IJsc¬eĦ`DCategory of Reservations Scheduled Caste

—eĦCaste -

Eligibility Clause code 4dŸeB2ģllisŏ a

BhLh2XS®eĽB`\¨eU<¬eÐZi^Dĺ2S\iD_ĹÐ 14000
.Annual Income of family from all source
Ļ¯lsbĻ§eDSĹÐĪs`ƒIJsc¬eĦdBh´Vœl[hĦÃsªe! Yes
Do you claim reservation under special category?
²qShIf Yes,
Do you belong to Anglo-Indain Community? No
Īs`ƒ52’liÐ62ģ[ŖcZh¡e[l´±lsĸĨsªe
Persons of Disability (PWD) No
EX - DEFENCE No
DEFENCE No
Hyderabad Karnataka No
Kannada No
Rural No
 PUC or 12th std Details
Year of passing II PUC 2021 PUC studied in which KARNATAKA
State?
PUC Roll No/Registraion No 117413 II PUC Board State Board

Have you studied English Yes II PUC Mathematics Yes

Passed
Max Marks in Maths 100 Obtained Marks in Maths 56

Subject Name Max Marks Minimum % Obtained Per(%) in Marks

Marks
Physics 100 30 67 67
Chemistry 100 30 58 58
Biology 100 30 72 72
English 100 30 88 88

Declaration
75Ŗ¬ltŖZh‘e2Q\Īsģ\h`<¬eвlsĺlD_…¨eĿĦD_…UZ’lĦĺSZġ¾’lcQͲeDhĪC\®l2Sh7Zi^BęisĽchŸlÃs®l7
5Ŗ¬ltŖ4ĝQh2Xh`ƒSl´c2X2ĩľS2Ÿl¨eĿĦltīģ[ĹвeDhl6<®lř±ltōUĹÐĪsģ\h`<¬eШeĿĦciG£lD_UhÇQh2¦e
<G¹ĸlĵ2S@Ĩ\hŸlÃs®l?2Sh®ls­l£e`ƒ5Ŗ¬ltŖZh‘e2Q\Īsģ\h`©e`ƒ¡ls¨eĿĦ[hQVƒÈ4R®e4cQÍ®l2ShB2NhX2SĹÐ
£e`ƒľsLUhÇ5Ķ´¨eNh`ZQhÐl6<ĵ2SľsLUhÇd2ělVœl[h`dB´UhÇB­lShli_…ÑŸlÃs®l²eDhªeIÍce\B£eLBVĸsďe
¤eÎĩe\`ƒ7c2X2TUZÌĻ\hSÆŸl’lShli_ÑXdh¡eSeUiUhĸsĦ[BÎZDĺ’lXSÆ£eĖ\hŸlÃs®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 shall forfeit the claim
to be considered or a seat selected and allotted by KEA. We are also liable for civil and criminal action, that the State
Government or the KEA may take against us in this regard.

ŪsbB\V†PcĿ<N 4YÍħ[<Nlt²l¦lÊ\_Dh\hQh 4YÍħ[V†PcĿ

lt²l¦lÊ\_Dh\hQh Left Hand Thumb Signature of the
impression of the Candidate Candidate
Signature of the Parent
/ Guardian

PaymentStatus

Application No Challan Number Bank Name bankrefno Amountpaid Paiddate

512386 KEA512386001 billdesk WSBI048737372 500.00 12/18/2021
4 11:22:31 AM

DZĪľ1<¬eÐVÎĔÎĶV†P’li2NU2Q\4YÍħ[h42ĦZVÎĦ[UhÇZhĨÎľli2Nh¡eC¬l
œeBhÍij2ōVĸļs^£lc2SYSĹÐ
BœeÀ[®eĖcĹÐc¦lsBh
2ľsLhd2ělVÎĔÎĶ[cZ[SĹÐ?SĖch`—eĦZQhÃ5¡e[VΨePVQÎ`ƒ5Ŗ¬ltŖ4ĝ[cZ[SĹÐUZiĨľS—eĦZQhÃ
5¡e[`ƒBœeÀ[®eĖ?2¡ls5Ė\¦lsBh42ĦZęisbžl[U2Q\©e`ƒ¡lse\PBi´—eĦ[ĹÐXS¬e`žl’l4`eaĻ\h`ƒĨ^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.

Printed Date: 22/01/2022