TS EAMCET - 2023 Conducted by JNTU Hyderabad on behalf of TSCHE Sheen nn g FILLED IN ONLINE APPLICATION FORM FOR COMPUTER BASED TEST(CBT) 1 Stream Applied Fort Engineering @) 21a) Qualifying Examination # ‘SBE INTERMEDIATE (REGULAR) (©) QuaivingEsam Latest Hall Ticket Number # : 2838014001 ae ae (© Year of Appeaing Passes the QualiyingEam : 2023 (@ Medium of Instruction at Qualfvine Exam: English forall itor corresponéence (© Flaca Sindy -IntemedateorEquvalest = Ua REGISTRATION NO : A1316617493F = IN 3. Matimof Tet Engin & Udo SYED MURTAZA SYED MAQSOOD (© Motes Name SHABANA (@ Date of Bith ( perSSCorEquivaen)# — : 14082 @ Birth State, Birth District TELANGANA- WARANGAL URBAN Gender Male < 5.@) Caterry# oc (Do you beng to Economically Weaker Xo Section EWS)? 6 Speial esenation Category # NA - 7. Physically CalengedPe) # AA §.@ Non Minocty Minority Non-Minaity (©) Minority Category NA eal Meakags 0. Azo lcon of tae Pants Rs) i Te 10, @)Study Des XT [ewes preER comNRY [eae preER commer [caset JoTHER couNTRY [case JoTHER counTRY [tase JoTeER coummRY lcasevt hvARANGAL URBAN [cases WARANGAL URBAN [Cassar WARANGAL URBAN [case [WARANGAL URBAN [Case WARANGAL URBAN fens [WARANGAL URBAN leat [WARANGAL URBAN (©) Local Area Based on Study Detail) Osmania Univenity OU) (© 10:2 Diploma Studd ie OTEER PRIVATE COLLEGES @ Pace of Stay -89C or Eguivent vitae (© SSC Hall Ticket Number, Moh & Yearof_ + 20250873, July 2020 Pasig 11. Losal Ara Flladby Candidat) eo 12. @ Ades for Crespondence 41-289, ths suanambods, haramkonda, telangana, 506001 (Candidate's Stents Mobile Number 1207512316 (E-Mail 14 # : knownasperfot gmail com (@) Aadhaze Card mamber/Eerolment mamber = so9e9936198 13 Test Zones - Preference -1 Preference -2 Preference -3 Warangal asinmagar Hiyderatad ‘U4, (@) Fee particulars - Payment through ONLINE, (©) Amount (inRs.): 900.00 (Payment Refeence ld ‘TSP132133267E6 Thess Fels CANNOT bedi by candice ut writen request can be ade tothe CONVENER, TS EAMICET.2025 o xl to eancthelp desk 025@jnnh ia Reming Sets canbe ‘ns canals curing th panes poe Fora stl conatat-o1-T4l6sui578 me n-Ta1 908215 [Declaration= 1) Thave coral gona throwsh the instruction bookiat and Tam conversant wih the instotions. I shall bids by the alsblity conditions and other sepslations tobe satisfied for appenring atthe computer based entrance test 2nd admission into any couse presebed, Further, Tassore 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 of llegal activities, Lam liable fer punishment a per the exiting la. _2) Lam sesponaille fr the deta filled by me ane the CONVENER, IS EAMCEI-2023 ie not responsible in any way ‘Mare appeatiag forthe entrance examination dost not confer any right for me to take aémision, |sstmittad Date :21/032023 6:46PM [Print Date: 21/032023 06:47 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 ie compat gnuated see and dots aot gui the signenee of ie CONVENER, TS EAMCET 2023