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Acknowledgement Slip

Fill-up the following details to get registered with Nua O Magic card
NABIN ODISHA MAGIC CARD
Registration Acknowledgement Slip

Ack Receipt No: Registration Date: Aadhar No:


5750164982535990 11-03-2024 20:03:47 xxxxxxxx7320

Course Name: SAMS Barcode No:


Under Graduate 23D107749

BASIC DETAILS

Student's Name: BEDABYASH MIRDHA

Father's Name: DURGESWAR MIRDHA

Mother's Name: KAIN MIRDHA

Gender: Male Date of birth: 18-08-2006

Mobile: 9692837418 Email ID: bedabyashmirdha@gmail.com

Address

Village: Regeda GP/Ward: Regada

Block/ULB: Karlamunda District: Kalahandi

PIN Code: 766102

ACADEMIC DETAILS

Institute Name Stream Name Subject Name Admission Year

Rayagada (Autonomus) College, Rayagada Biological Science Botany 2023

INTEREST & CAREER PREFERENCE

Interest Areas: Dancing, Hacking, Mathematics, Aspire to be: Agricultural Scientist, Animation
Meditation, Painting, Science, And Multimedia Artist, Doctor,
Writing, Yoga Environmental Consultant, Fintech
Specialist, Health Informatics
Specialist, Indian Police Services
(IPS) Officer, Medical Professional,
Odisha Administrative Services
(OAS) Officer, Web Developer

Prefer to upskill for Health and Wellness Skills Expectation from the For online classes
better career: card:

Part of any NGO: No Prefer to volunteer: Yes

I hereby declare that the information given above is true to the best of my knowledge and belief and nothing has been
concealed therein. I understand that if the information given by me is proved false/not true, I will have to face the
punishment as per the law. Also, all the benefits availed by me shall be summarily withdrawn.

Signature of the Student

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