ODISHA UNIVERSITY OF AGRICULTURE & TECHNOLOGY

APPLICATION FORM-A
FOR ADMISSION INTO UNDER GRADUATE COURSES - 2023

Applicant Details

Applicant Name PRATIVA SAHOO Application No. ACK01022624

Mother's Name SASMITA SAHOO Father's Name RABINDRA KUMAR SAHOO
Date of Birth 29/08/2005 (Age as on 31.12.2023) 18 Years 4 Months 2 Days
Gender Female Religion Hindu
Blood Group B+ Parents Annual Income Below 1 Lakhs
Category UR Mother Tongue Odia
Nationality INDIAN Email prativasahoo2021@gmail.com
Mobile Number 6370726153 Alt. Mobile No. 9437735445

Present Address Permanent Address

Address FATEPUR, BHANDARI POKHARI, BHADRAK Address FATEPUR, BHANDARI POKHARI, BHADRAK
District Bhadrak District Bhadrak
State Odisha State Odisha
Country India Country India
Zip Code 756120 Zip Code 756120

Domicile Information
Has the Candidate passed Odia as one of the Subject in HSC entrance Exam from any School/Institute of Odisha? Yes
Ability to read, write and speak Odia language Read , Write , Speak

Choice of Center
First Choice Bhadrak Second Choice Jajpur Third Choice Cuttack

Subject for Entrance Examination. (Physics & Chemistry are compulsory subjects. Choose optional subjects either Mathematics or Biology).
Refer clause 4.2(b) of UG Prospectus 2023-24.
Subject selected for Entrance Examination. Physics, Chemistry, Biology

Payment Details
Payment Date Reference No. Receipt No. Amount (₹) Status
04/05/2023 TXOUAUG40520230072564 RTOUAUG40520230059578 1500.00 Payment Successful.

Declaration
I, PRATIVA SAHOO do hereby declare that the information submitted by me in the application is true to the best of my knowledge and belief. I have
applied for OUAT UG admission 2023 with the consent of my Parents and Guardians.
1. N.B Form-A is editable till the last date of submission
2. N.B Form-B submission is mandatory for admission. Refer to Clause 4.7 of UG prospectus 2023-24