UNIVERSITY OF LUCKNOW

Online Application Form for Admission - 2023

(Undergraduate Professional Programmes (BCA & BBA))
LURN : LU2300053766 REGISTRATION ID : 20236018167
PERSONAL DETAILS
Name of Programme : BBA
Name of Student : RAJNISH KUMAR PATHAK
Father's Name : BALRAM PATHAK

Mother's Name : MANJU DEVI

Date of Birth : 03/11/2000
Mobile Number : 8102753653
E-Mail ID : rajnishemail0000@gmail.com
Gender : Male
Domicile : Other Religion : Hinduism
(SC/ST and OBC category candidates of outside UP will be treated as General for Counselling Purpose.)
Category : General Caste Certificate Number : -
Annual Income of
: Below 200000.00 Nationality : Indian
Family (in Rs.)
Sub Category : -
Weightage : Sports Income Certificate No. :-
Zero Fees Required : No
Is Father's Income below Rs. 2,00,000 Per Annum ? : No Blood Group : O+
ID Proof : Aadhaar Card ID Number : 394355752962

ADDRESS FOR CORRESPONDENCE PERMANENT ADDRESS

Address : BELTHARI GOPALGANJ BIHAR Address :BELTHARI GOPALGANJ BIHAR
Gopalganj Gopalganj
Bihar, India, Pin Code - 841503 Bihar, India, Pin Code - 841503
Mobile Number : 8102753653 Alternate Mobile Number : - Mobile Number : 8102753653 Alternate Mobile Number :-
Landline With STD Code : - Landline With STD Code : -

BANK DETAILSSelf
Account Holder Name : RAJNISH KUMAR PATHAK Bank Name : Central Bank of India
Account No. : 3608938763 IFSC Code : CBIN0281314

EDUCATIONAL QUALIFICATION
HIGH SCHOOL OR EQUIVALENT EDUCATION
Roll Number : 5080557 Passing Year : 2017 Percentage : 64.50% Maximum Marks : 600
Marks Obtained : 387 Examination Body of the High School or Equivalent Education : C.B.S.E. Board
INTERMEDIATE/POLYTECHNIC OR EQUIVALENT EDUCATION
Passing Status : Passed Roll Number : 216847077 Appearing/Passing Year : 2021

Maximum Marks : 500 Marks Obtained : 338 Percentage : 67.60%

Examination Body of the Intermediate or Equivalent Education : U.P. Board
SUBJECT-WISE MARKS OBTAINED IN INTERMEDIATE
CHEMISTRY(73/100),ENGLISH(57/100),HINDI(61/100),MATHEMATICS(73/100),PHYSICS(74/100)

FEE PAYMENT DETAILS

Amount (In Rs.) : 1,000.00 Transaction No. : ADM220000658358 Transaction Date : 31/05/2023

DECLARATION : I hereby declare that all the Information being provided by me in the Application Form are true and correct to the best of my
knowledge. I understand that if at any stage of the Admission process any of the provided information is found to be wrong or incorrect I will be
solely held responsible for it and my application or candidature shall be liable for rejection.

Signature of Student

NOTE : Kindly keep the printout of the Application form with you. You have to bring the printout of the Application Form only at the
time of Counselling. Do not send any printout to the University of Lucknow by post or by hand.

Print Date : 31/05/2023 Page 1 of 1