TS EAMCET - 2023 Conducted by JNTU Hyderabad on behalf of TSCHE FILLED IN ONLINE APPLICATION FORM FOR COMPUTER BASED TEST(CBT) 1. Stream Applied Fort 2a) Qualifying Examination # (©) Qualifying Exam Latest Hall Tcket Number # (© Year of AppearngPassed the Qualifying Exam. (@) Mediom of Instruction at Quatfying Exam (© Flace of Study -Intemnedite oc Equivaleat ( Bridge Course Hall Ticket No. (any) 3. Medium of Test 4. (@) Candifate’s Name # (®) Fathe’s Name (© Mothers Name (@ Date of Bist (as per SSC or Equivalent) # (© Birth State, Birth District (0 Gender 5.(@) Category # (B) Do yeu belong to Economically Weaker Sectioa(EWS)? 6. Special Reservation Category # 7. Physically Challenged(PH) # 8.@) Non-Minocity / Minority (©) Minocty Category 9. Annual Income of the Parents Rs) 10. @) Study Details Ito XIE Engineering (2) CBSE (10+2) 20607468 2023 English Urban NA English & Telogs NALLA PRANAY KRISHNA NALA SRINIVASULU NALA VUETHA 26/112005 OTHER STATE - OTHER STATE Male ‘Brasarve the below REGISTRATION NUMBER forall fstue correspondence REGISTRATION NO : A1318153019C fewest [RIFOTTSRIRAMULUNELLORE [Case [ser POT SRI RAMULU NELLORE [otass-mm [SRIFOTTISRIRAMULUNELLORE [Gass.IV [ski POTTI SRI RAMULU NELLORE [ctss-¥ [SRIFOTTISRIRAMULUNELLORE _[Gass-V1 [ski POTTI SRI RAMULU NELLORE [otss-vt [SRIFOTTISRIRAMULUNELLORE _|Cass-VI [ceTTOoR [ctass-2x |cexTTOOR loass-x. [cenTTOOR let [cHTTTOOR ae [cEITTOOR (©) Local Area Based on Study Details) Si Venkateswara University (SVU) (© 102 ' Diploma Studied Is ‘OTHER PRIVATE COLLEGES (@ Place of Study -SSC or Equivalent Uibas (© SSC Hall Tiket Number, Moh & Yearof 20121261, May -2021 1 Lol t Pedy Canta) Si Venkateswara University (SVU) 12. @ Adress for Correspondence 2.201, PULICATE NAGAR, Sullupera, NELLORE, Andtra Pradesh, 514121 (o)Candidates Student's Mobile Number # 9492051034 ) E-Mail 14 # nallasins93@gmailcom @ Aadhuar Card number /Exrolment asmmber 13.Test Zones 552038549472 Preference 1 Preference -2 Preference 3 Tirwpati ‘Vijayawada Komool 14, @)Fee particulars - Payment through ONLINE (© Amoutt (ns): 90000 (Payment Reference Id ‘TSP13246986353 #2: Thas Fale CANNOT Sindy anda, bt weitere ab mada tothe CONVENER, TS EAMCET.2025 oni to nanathalp sk C05 jan in Ramsay Sots canbe and ‘rtacanaiste rng th pated poe Foran tls coiat at 91-T416525578 mad 1-761 6908215, [Declaration {TD Thave exefuly gone through the ietrotion bookset and lam conversant withthe introctionsIahall abide by the sigbllty conditions and other ‘epilation tobe satisfied for appairing atthe computer basa antrance test and admission into any couse prasriba, Further, Tasers that, Iwill ‘a0: involve in any malpractice or illegal activities in the entrance test, In case, Ihave fonished any flee information or involved in ans] smulpractie o illegal actvitne, Lam lle for pnisherant 8 por the exiting tw. 12) Tam responsi fr the detail filled by me and the CONVENER, TS EAMCET-2023 isnot responsible in any way ‘Mare appeatiag forthe entrance examination dost not confer any right for me to take admision, |ssomitted Date 081082023 10:57 AN [Print Date: 081042023 10:57 AN SIGNATURE OF THE CANDIDATE in the presence of the Invigilator and ssbmit to Invigilator en the ay of Examination LIFT HAND THUMB Impression of the candidate to be done well in advance(aileast a day before the examination) Affix a recent colow: photosrarh, (G5 emX3.5 cm) (Well im advance BEFORE EXAMINATION) v Tat Hand Themb Impression As [Sct ALL ca canases have to sm his Sem ie te Exaaton Hall ta lvls 2) Canéiats ae ant alleved ito th Examination Hal even ther ae LATE BY 4 MINUTE. 2) This is compat gunaated see and dots not gui the signenee of ie CONVENER, TS EAMCET 2123