ODISHA UNIVERSITY OF AGRICULTURE & TECHNOLOGY

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

Applicant Details

Applicant Name OM PRAKASH MALLICK Application No. ACK01029586

Mother's Name KOUSALYA MALLICK Father's Name ASHISHA KUMAR MALLIK
Date of Birth 09/05/2005 (Age as on 31.12.2023) 18 Years 7 Months 22 Days
Gender Male Religion Hindu
Blood Group O+ Parents Annual Income 5 Lakhs to 10 Lakhs
Category SC Mother Tongue Odia
Nationality INDIAN Email ashisham014@gmail.com
Mobile Number 9337142428 Alt. Mobile No. 8144245585

Present Address Permanent Address

Address ABHINAV BIDANASI , NEW COLONY Address ABHINAV BIDANASI , NEW COLONY
District Cuttack District Cuttack
State Odisha State Odisha
Country India Country India
Zip Code 753014 Zip Code 753014

Domicile Information
Has the Candidate passed Odia as one of the Subject in HSC entrance Exam from any School/Institute of Odisha? No
Residence Type Domicile of odisha

Choice of Center
First Choice Cuttack Second Choice Bhubaneswar Third Choice Puri

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, Mathematics

Payment Details
Payment Date Reference No. Receipt No. Amount (₹) Status
08/05/2023 TXOUAUG80520230082024 RTOUAUG80520230067395 1500.00 Payment Successful.

Declaration
I, OM PRAKASH MALLICK 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