Government of Karnataka

Karnataka Examinations Authority

Common UG Online Application - 2024
2024

2024-25 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm
Science courses [B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental,
Ayurveda, Unani, Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2024-25

Final Copy Appln No: 42467310

Online Application Form

I.General Details

Candidate Name : JYOTHILEKSHMI J

ತಂದ Father Name/Guardian Name JAYACHANDRAN A S

Mother Name PRATHIBHA D

ಂ Date of Birth 05-01-2007

ಂ Mobile Number & Email 82XXXXXX94 - p****5@g****l.com

Candidate Nationality INDIAN - Resident of India

ಂ Candidate Gender FEMALE

Candidate Address THEKKUMVILAYIL, KOKKADU (PO),KOTTARAKKARA,

KOLLAM, OUTSIDE KARNATAKA, OUTSIDE
KARNATAKA, KERALA - 691538
Caste Reservation Claimed / Income Details

Religion HINDU

Reservation category - OPN - GM

Name of the Caste

ತ ಂ
Caste Certificate RD Number
ದ ತ ಂ Income Certificate RD
Number
Annual Income

Other Reservation claimed Details

RELIGIOUS MINORITY NO
LINQUISTIC MINORITY NO
STUDY IN KANNADA MEDIUM FROM 1 TO 10TH NO
STUDY IN RURAL AREAS FROM 1 TO 10TH NO
JAMMU & KASHMIR MIGRANTS NO
KALYANA KARNATAKA (371 (J)) NO
Printed Date: 10-02-2024 06-47-41 Page No: 1
 Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application - 2024
2024

2024-25 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm
Science courses [B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental,
Ayurveda, Unani, Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2024-25

Final Copy Appln No: 42467310

NRI-WARD NO

Academic Details
Quota claimed / ತ Eligibility Clause Code NON-KARNATAKA - CLAUSE - Y

ತೃ ಭ ಷ Mother Tongue OTHERS

Do you write/appearing Board Exam of 12th in Karanataka? No
ಂ ಂ ತ 0
Total number of years of study in Karnataka (From 1st to 12th Std.)
ಂ KERALA
State of 2nd PUC / 12th/ Equivalent exam & Qualifying Examination Board
College Type AIDED COLLEGE
ಂ KERALA
State of 2nd PUC / 12th/ Equivalent exam & Qualifying Examination Board
District of 2nd PUC/12th/Equivalent exam (if studied in karnatka) OUTSIDE KARNATAKA
ದ ಂ PUC Student Number & Year of 23041308 - 2024-
Passing
ಂ NO - 467310

Completed SSLC from KSEEB, Govt. of Karnataka? and Registration

Number
ಂತ ಂ NO

Have you Appeared for NEET Exams before 2023? / CET Number / Year of
appearance

Applied Courses
UG - CET Enggineering/Nursing/Veternary/Yoga & Naturopathy/Agriculture/Pharmacy
UG- Medical/Dental & Ayush (UG NEET)

Exam Ceners
Exam Center (Priority 1) BENGALURU NORTH
Exam Center (Priority 2) MYSURU (MYSORE)

Printed Date: 10-02-2024 06-47-41 Page No: 2

 Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application - 2024
2024

2024-25 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm
Science courses [B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental,
Ayurveda, Unani, Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2024-25

Final Copy Appln No: 42467310

Study Details
ಂ

Name and Address of the District ತ Passed Passed Board Area Medium
School and Address Class Year
VIMALAMBIKA LPS Outside 1 2013 KERALA - -
,KOTTARAKKARA, KOLLAM, Karnataka
KERALA
VIMALAMBIKA LPS Outside 2 2014 KERALA - -
,KOTTARAKKARA, KOLLAM, Karnataka
KERALA
VIMALAMBIKA LPS Outside 3 2015 KERALA - -
,KOTTARAKKARA, KOLLAM, Karnataka
KERALA
VIMALAMBIKA LPS Outside 4 2016 KERALA - -
,KOTTARAKKARA, KOLLAM, Karnataka
KERALA
MT HS PULAMON Outside 5 2017 KERALA - -
,KOTTARAKKARA, KOLLAM, Karnataka
KERALA
MT HS PULAMON Outside 6 2018 KERALA - -
,KOTTARAKKARA, KOLLAM, Karnataka
KERALA
MT HS PULAMON Outside 7 2019 KERALA - -
,KOTTARAKKARA, KOLLAM, Karnataka
KERALA
MT HS PULAMON Outside 8 2020 KERALA - -
,KOTTARAKKARA, KOLLAM, Karnataka
KERALA
MT HS PULAMON Outside 9 2021 KERALA - -
,KOTTARAKKARA, KOLLAM, Karnataka
KERALA
MT HS PULAMON Outside 10 2022 KERALA - -
,KOTTARAKKARA, KOLLAM, Karnataka
KERALA
Govt. MODEL HSS Outside 11 2023 KERALA - -
VETTIKKAVALA Karnataka
,KOTTARAKKARA, KOLLAM,
KERALA
Govt. MODEL HSS Outside 12 2024 KERALA - -
VETTIKKAVALA Karnataka
,KOTTARAKKARA, KOLLAM,
KERALA
Printed Date: 10-02-2024 06-47-41 Page No: 3
 Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application - 2024
2024

2024-25 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm
Science courses [B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental,
Ayurveda, Unani, Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2024-25

Final Copy Appln No: 42467310

Bank Details
Account Holder PRATHIBHA D Bank Name Uco bank
Name
IFSC Code UCBA0002906 Bank Branch Kottarakkara
Account Number 29XXXXXXXXX870

Payment Details
AppNo 42467310 Bank Ref No. YHD42230674939
Application Fee Rs. 2500 Bank Name Bill desk
Paid Date 10/02/2024

Uploaded Documents List

SSLC/10th standard Marks Card or equivalent Certificate
Passport Size Photo
Thumb Photo
Signature

1 ಂ ಂತ ಂ ಂ ದ ಂ ಂ

2 ಂ ತ ದ ತ ತ
ದ ಂದ ಂ ಂತ ದ
NOTE : 1. After completion of all the process the candidates are required to take final print out of the Online Application
Form and submit the same during Document Verification.
2. The CASTE and INCOME certificate to be produced by candidates during seat selection process should have the
same CASTE and INCOME, as mentioned in this Application Form. No change in Caste / Category will be
permitted after the final declaration.

Declaration

ಂತ ತ ಂ
ತಂ ಂ ಂ ಂ
ತಂ ಂ ಂ ಂತ ದ
ತ ತ ಂ ಂ ಂ ಂ ಂ ದ

We declare that the information furnished through online is true and correct to the best of our knowledge and
belief. We have read the instructions carefully hosted on the KEA website "Information Bulletin for Filling up of
Online Application". In case any of the information furnished online by us is found to be false or incorrect, We are
also liable for action, that the State Government or the KEA may take against us in this regard.

Printed Date: 10-02-2024 06-47-41 Page No: 4

 Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application - 2024
2024

2024-25 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm
Science courses [B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental,
Ayurveda, Unani, Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2024-25

Final Copy Appln No: 42467310

Left hand Thumb of

Signature of the
Candidate
Candidate

Printed Date: 10-02-2024 06-47-41 Page No: 5