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    Murali Pattar
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    The document is an application form for a polytechnic institution. It requests information from the applicant such as name, photo, program details, examination results, mobile number, and date of birth. The applicant is asked to declare that the provided information is true and accurate. Once completed, the applicant can submit the form by clicking the appropriate button at the bottom of the page.

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    The document is an application form for a polytechnic institution. It requests information from the applicant such as name, photo, program details, examination results, mobile number, and date of birth. The applicant is asked to declare that the provided information is true and accurate. Once completed, the applicant can submit the form by clicking the appropriate button at the bottom of the page.

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    © All Rights Reserved
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    5 views3 pages

    Unsigned

    Uploaded by

    Murali Pattar
    The document is an application form for a polytechnic institution. It requests information from the applicant such as name, photo, program details, examination results, mobile number, and date of birth. The applicant is asked to declare that the provided information is true and accurate. Once completed, the applicant can submit the form by clicking the appropriate button at the bottom of the page.

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    Application Form /
    ಅ

    Applicant Full Name/ಅ ರರ Shridhar Pattar


    ಣ ಸರು :

    Photo(3.5cm x
    4.5cm)/ ೕ ೂೕ(3.5cm x 4.5cm)
    (Kindly upload a clear photograph /
    ದಯ ಟು ಸಷ ದ ವ ತ ವನು
    ಅ ೂೕ ):

    Scheme/ ಜ : Semester/ ಸ

    Register Number/ ೂೕಂದ ಸಂ : 511cs18021

    College Code/ ೕಜು ೂೕ : 511

    College Name/ ೕಜು ಸರು : K L E S POLYTECHNIC

    College Location/ ೕಜು ಸಳ : MAHALINGAPURA

    Mobile Number (SMS notifications 7975694838


    will be sent to this number)/ ೖ
    ಸಂ (ಎ .ಎಂ.ಎ ಸಂ ೕಶಗಳನು ಈ
    ಸಂ ಕಳು ಸ ಗು ದು) :

    Hidden DOB for eKYC : 07-09-1999

    Particulars of Examination/ಪ ೕ ಯ ವರಗಳು


    Particulars of Examination/ಪ ೕ ಯ ವರಗಳು

    Semester/ ಸ Month of Examination/ಪ ೕ ಯ ಂಗಳು Year of Examination/ಪ ೕ ಯ ವಷ Result/ಫ ಂಶ

    1 December/ ಂಬ 2018 Pass/

    2 May/ ೕ 2019 Pass/

    3 December/ ಂಬ 2019 Fail/ ೕ

    3 May/ ೕ 2020 Pass/


    4 May/ ೕ 2020 Pass/

    5 December/ ಂಬ 2020 Pass/

    6 May/ ೕ 2021 Pass/

    Date of result announcement of 20/12/2021


    final examination taken (including
    all attempts)/ಅಂ ಮ ಪ ೕ ಯ
    ಫ ಂಶದ ಪ ಕಟ ಯ ಂಕ. :

    Date of result announcement of July 2021


    final examination taken (including
    all attempts)/ಅಂ ಮ ಪ ೕ ಯ
    ಫ ಂಶದ ಪ ಕಟ ಯ ಂಕ old :

    Selected College : K L E S POLYTECHNIC - 511

    Declaration /
    ೂೕಷ

    I hereby declare that the particulars furnished in this form are true to the best of my knowledge/ಈ ಅ ಯ ನನ
    ಅ ಂದ ಒದ ರುವ ಎ ವರಗಳು ೖಜ ರುತ ಎಂದು ೂೕ ಸು ೕ .

    I Agree : Yes

    Annexure List

    1) Photocopy of SSLC or 10th Marks Card Photocopy


    Standard Marks Card

    Additional Details

    Apply to the Office Polytechnic Institutions Office(Polytechnic Institutions- K L E S


    POLYTECHNIC - 511 )

    Draft Reference No : TE001S230011733

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