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APPLYING FOR

APPLYING FOR HAVE YOU BEEN ALLOTED A COMEDK SEAT

PCM-COMEDK UGET ONLY IN PREVIOUS YEARS
NO

Personal Details

APPLICATION STATUS APPLICATION NUMBER

PaymentSuccess KCU0088023
FULL NAME OF THE APPLICANT CANDIDATE NAME AS PER GOVT ID PROOF
RAMAN RAMAN
EMAIL ADDRESS MOBILE NUMBER
Ramandalal01@gmail.com 8396803639
DATE OF BIRTH UNIQUE ID PROOF OF APPLICANT
15/Dec/2004 PAN CARD
UNIQUE ID PROOF NUMBER OF APPLICANT GENDER
GFNPR1458P MALE
NATIONALITY
Indian
PERSON WITH DISABILITY(PWD) WHETHER YOU NEED SCRIBE?
NO NA
PARENT'S ANNUAL INCOME
LESS THAN RS 6.5 LACS P.A

Parent's Information

FATHERS'S FULL NAME MOTHER'S NAME

SURESH BIRMATI
FATHER/MOTHER OCCUPATION OTHER OCCUPATION
OTHERS FARMER
PARENT'S MOBILE NUMBER PARENT'S UNIQUE ID PROOF
9813103639 PAN CARD
PARENT'S UNIQUE ID PROOF NUMBER
IBIPS1063L

Present Address For Communication Purpose

ADDRESS NAME OF NEAREST POLICE STATION TO

V P.O MASUDPUR , HANSI , HISAR YOUR PRESENT ADDESSS
HANSI
PRESENT ADDRESS STATE PRESENT ADDRESS DISTRICT
HARYANA HISAR
PRESENT ADDRESS OTHER DISTRICT PRESENT ADDRESS CITY
NA HANSI
PRESENT ADDRESS PIN CODE IS YOUR PERMANENT ADDRESS SAME AS
125049 PRESENT ADDRESS?
Yes
Permanent Address

ADDRESS ADDRESS STATE

V P.O MASUDPUR , HANSI , HISAR HARYANA
ADDRESS DISTRICT ADDRESS OTHER DISTRICT
HISAR NA
ADDRESS CITY ADDRESS PIN CODE
HANSI 125049

Category Details

BELONGS TO BIRTH/DOMICILE
NON KARNATAKA NA
LINGUISTIC MINORITY
NA
DO YOU BELONG TO KALYANA KARNATAKA KALYANA KARNATAKA REGION(HK Region)
REGION (HK Region)? NA
NA CATEGORY
GENERAL MERIT (GM)

Academic Details

QUALIFYING EXAM OTHER QUALIFYING EXAM

12th STD NA
QUALIFYING EXAM COMPLETED/ PURSUING MONTH AND YEAR OF PASSING QUALIFYING
COMPLETED EXAM
APRIL
2022
BOARD OF QUALIFYING EXAM
STATE BOARD
OTHER BOARD OF QUALIFYING EXAM NAME OF INSTITUTION LAST STUDIED
NA ASPIRING CARRERS
NAME OF INSTITUTION LAST STUDIED CITY IN WHICH YOUR INSTITUTION IS
HARYANA LOCATED(LAST STUDIED)
HISAR
ROLL/REG/INDEX NO./UNIQUE ID OF 10TH ROLL/REG/INDEX NO./UNIQUE ID OF 12TH
STD MARKS CARD STD/2ND PUC MARKS CARD
17182431 3022112795
OTHER ENTRANCE EXAM YOU ARE
APPEARING
IIT-JEE

Exam City Preferences

EXAM CITY PREFERENCE 1 EXAM CITY PREFERENCE 2

HARYANA-HISAR HARYANA-GURUGRAM
EXAM CITY PREFERENCE 3
HARYANA-FARIDABAD

Payment Details

Amount Payment Mode

1800 online
Payment Status Payment Transaction No.
SUCCESS 17197130584
Order ID
KCU008802320230417202428

Student Documents

Photo Signature

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Parents Documents

View /
Document
Download

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Click here.
THE APPLICATION:

Declaration

I declare that I have read the Exam Brochure, instructions and am conversant with the Online
process of submission of application.

I am fully aware that the application fee prescribed by COMEDK /ERA Foundation will not be
refunded for any reason including judicial and other statutory reasons.

I hereby declare that the information given above is true and correct to the best of my knowledge
and belief. I further declare to submit all certificates in original at the time of admission / Counseling
relevant to my claims made in the application. I also agree to forfeit my claim for admission in the
event of failure to produce the relevant original certificates. I shall abide by the Rules and
Regulations of COMEDK/ERA Foundation.