ODISHA UNIVERSITY OF AGRICULTURE & TECHNOLOGY

APPLICATION FORM-A
FOR ADMISSION INTO UNDER GRADUATE COURSES - 2024

Applicant Details

Applicant Name SNEHASMITA SAMANTARAY Application No. ACK01002323

Mother's Name SABITA SAMANTARAY Father's Name RADHAKANTA SAMANTARAY
Date of Birth 24/05/2006 (Age as on 31.12.2024) 18 Years 7 Months 7 Days
Gender Female Religion Hindu
Blood Group O+ Parents Annual Income 1 Lakhs to 3 Lakhs
Category UR Mother Tongue Odia
Nationality INDIAN Email snehasmitasamantaray@gmail.com
Mobile Number 6370767289 Alt. Mobile No. 7978513237

Present Address Permanent Address

Address AT - DOCHHIAN, PO - ADAL, PS - GADISHAGODA ,BLOCK Address AT - DOCHHIAN, PO - ADAL, PS - GADISHAGODA ,BLOCK
- KANAS - KANAS
District Puri District Puri
State Odisha State Odisha
Country India Country India
Zip 752019 Zip 752019
Code Code

Reservation Quota Details

Claimed Reserved Seat Category :
Person With Disabilities NO

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 Bhubaneswar Second Choice Puri 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 2024-25.
Subject selected for Entrance Examination. Physics, Chemistry, Biology

Payment Details
Payment Date Reference No. Receipt No. Amount (₹) Status
08/03/2024 TXOUAUG80320240089823 RTOUAUG80320240073774 1500.00 Payment Successful.

Declaration
I, SNEHASMITA SAMANTARAY 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 2024 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 2024-25