TS EAMCET - 2022 Telangana State Engineering, Agriculture & Medical Common Entrance Test Conducted by JNTU Hyderabad on behalf of TSCHE FILLED IN ONLINE APPLICATION FORM FOR COMPUTER BASED TEST(CBT) 1. Stream Applied For # Engineering @) 2.@) Qualifying Examination # ‘TSBIE INTERMEDIATE (REGULAR) © QuaivngEan Latest Fal Tet None: 20st a eee ©) Year of Appearing Pissing the Qualiying Exam : 2022 . (@) Medinm of Instruction at Quabiving Exam = English forall fitore correspondence (@) Place of Study -Intemedate ocEquvaleat = prep REGISTRATION NO : A121455897C3 (O Bridge Course Fall Tcket No. Gf any) NA AM 3. Matiom of Test English & Tologs KOMARAMLAVANYA KOMARAMNARASIMHARAO (© Mother's Name KOMARAM LAXMI (@ Date ofBith as per SCorEquivalnt) # = 2000424 @ Birth State, Birth District TELANGANA - BHADRADRI KOTHAGUDEM (© Gender Female 5.G@) Catezony # sv (©) Do you belong to Economically Wesker NA SectionrEWS)? 6. pedal Reservation Category # NA 1 Physically ChalengedPED # NA 8.@) Non-Minocty / Minoity Non Minority (©) Minosty Category NA 0, Anal Income of the Parents Re) Balow 1 Lakh 10. @)Study Deals Ito MT [owes BHADRADRIKOTHAGUDEM ——_[CaseT [BHADRADRIKOTHAGUDEM loses [BHADRADRIKOTHAGUDEM ——_|Cass.IV [SHADRADRIKOTHAGUDEM lowss-v [BHADRADRIKOTHAGUDEM ——_|Cass-VI [SHADRADRIKOTHAGUDEM [otss-var [BHADRADRIKOTHAGUDEM ——_|Case-Vill [SHADRADRIKOTHAGUDEM [omesix [BHADRADRIKOTHAGUDEM [Case [SHADRADRIKOTHAGUDEM fewer BHADRADRIKOTHAGUDEM fine [HADRADRIKOTHAGUDEM (©) Local Area (Based ot Study Deals) ‘Osmania Univesity (OW) (© 10+2 | Diploma Studed Ie GOVT COLLEGE (©) Pice of Study -S5C or Equivalent Rural © SSC Hall Ticket Number, Month & Year of 2009107965 , March - 2020 Passing 1, Lotal Area Gilladby Candidats) ‘Geen 12. @ Address for Comespondence $.26, MONDIKUNTA, NELLIPAKA, BHADRADRIKOTHAGUDEM, TELANGANA, 507116 (@3Candidate's/ Students Mobile Number# ——: gtgaso (20 MaUA: HigfeininiondDO Ngee (@) Aadhaar Card number / Enrolment namber >g2709088125 ee @ 13 Test Zones = 7 Prefrene 1 Preferene 2 Prefer 3 Satopally Saompet Vinyavada ‘U4, (@) Fee particulars - Payment through ONLINE, (©) Amount (inRs.): 400.00 (©) Payment Reference 6 TSPIDNTESISTEL Thess Fels CANNOT edited by candice, ut writen request can be ade to the CONVENER. TS EAMICET-2021o mil to convert sance@uicheacia Rensnig fel can be died by (Gactcate cag ne pile perio Forany cals oaacat*9-SSII018539 286-91 5103937509 [Declaration= 1) Thave coral gona throwsh th intrastion bookiat and Tam conversant with the instotions. I shall bids by the alsblty conditions and other sepslations tobe satisfied for appanring atthe computer based entrance test 2nd admission into any couse presered, Further, Issue that, Iwill ‘not involve in ary malpractice © ileal activities in the entrance test. In case, Ihave fersished any flee information or involved in any| ‘malpractice o illegal actvitas, Lam liable fer punishment a per the existing Lav. 12) Tam responsi for the cosrastnes of the above details lle by me ané the CONVENER, 1S EAMCIT-2022 isnot ssporsible in anyway. ‘Mare appeatiag forthe entrance examination dost not confer any right for me to take admission, |sstmitted Date :20/0520222:12PM [Print Date: 20)052022 02:13 PML sy SOSATURE OFTHE CANDDATE | serazanp THUND tmprenon fe cnn toe dene well a siccuedeticast o dny before Govexcetinsion) Tevet th cay of Ban “6 ay > Alfie reset elooe plotoagh Jo 3 cn3 5 cx) Well in advance Taf Hand Thon Inpresion BEFORE EXAMINATION) v Z = [Sct 1) ALL ce candawes have to smi hie Som ie te Examieaton Hall ta lvienoe 2) Canéits ae ant alloved ito th Examination Hal even ther ae LATE BY 4 MINUTE. 2) This is compat gnuated see and dots aot gin he signanee of tte CONVENER, TS EAMCET 2022