Candidate's Details

Application Number : 109283

1 Course/s Applied for PGCET : M C A (only)FullTime

2 Name of the Candidate : VIJAYALAKSHMI V

3 Name of the Father : VENUGOPAL S
4 Name of the Mother : PRAMODA DEVI V
5 Date of Birth : 27:10:1999
6 Gender : Female 7 Quota : Karnataka
8. Marital Status Single Spouse Name

9. Annual Income of the family from All Sources (If married include your spouse 30000
income also)
10 Category : Category-2A 10 a. Sub-Caste : DEVANGA
Income RD Number (RD00-------) RD0038882348461
Caste RD Number starting with (RD0--------)

11 Religion : Hindu
12 Eligibility Clause Code: a
13 Qualifying Degree / Engineering Branch ? B.C.A (3 Years Degree)

Study Information
Qualifying Degree Status ? Appeard University Seat No : (USN) BC170245
Qualifying Degree College Name : SBRR MAHAJANA FIRST Qualifying Degree University UNIVERSITY OF MYSORE
GRADE COLLEGE Name :
Total Number of Years of Study in Karnataka : 17
Particulars of Result Month of Passing Year of Passing Maximum Marks Secured Marks
Examination
1 Pass May 2018 1600 1160

2 Pass May 2019 1650 1107

3 Awaiting August 2020 800 574

14 Do You Claim Reservation Under Physically Disabled Quota ? No

15 Do You Claim Reservation Under Ex-Serviceman Quota ? No
16 Do You Claim Reservation Under 371(J) (Hyderabad Karnataka) Quota ? No
16 (a) 371(J) RD Number starting with (RD0--------)

M.Tech Program Details (Only for M.tech Candidates)

PGCET Appearing under :

PGCET Exam Appearing Course Name :

Have you Appeared for GATE during 2019 or 2020 ?

GATE Code :

GATE Score : 0

Do You Claim Seat under Sponsered Quota?

17. PGCET Examination Centre MYSORE (MYSURU)

Candidate's Postal Address for Communication

Address : 862 1 KAMATAGERI MANDI MOHALLA MYSORE,,MYSURU,MYSORE(MYSURU),KARNATAKA-
570001
Mobile No : XXXXXXXXXX
Email : XXXXXXXXXX@XXXXXXXX

Declaration
 I declare that the above information is true and correct to the best of my knowledge and belief. I have gone through the
relevant Government Orders, Admission Rules and all Notifications / Website Notification issued by competent Authorityfor
PGCET-2019 and understand the same.If any of the information furnished above is found to be false or incorrect, I shall
automatically forfeit my claim to be considered for a seat or the seat already been opted by me in a Professional College in
Karnataka. In such event, I will also liable for such civil and criminal action as the State Government / KEA may take against me
in this regard.

Signature of the Left Hand Thumb impression of Date:

Candidate the Candidate

Principal / Gazetted Officer Signature

Name:
Signature:

Seal:

PAYMENT STATUS
Appno : 109283 NAME OF THE CANDIDATE : VIJAYALAKSHMI V
APPLICATION FEES : 650 BANK NAME : NEFT/RTGS/IMPS Payments from
any Bank Account to Corporation
Bank
BANK CHARGES : 0 BANK Ref NUMBER : 1190932747

Printed Date 25-06-2020 03-13-06