KARNATAKA STATE OPEN UNIVERSITY

Mukthagangotri, Mysuru-570006

Application Number : 20120339 Date : 31/12/2020

Online admission Application for M.B.A I YEAR 2020-21 July Session Level: NA

Applicant's Basic Details

Name NEHA KAKKERI

Father/Husband/Guardian
Name MADHAVRAO KAKKERI

Mother Name MADHURI KAKKERI

Email Id aarunkumarchavan83@gmail.com

Mobile 9448532203

Date of Birth 23/11/1995

Gender FEMALE

Nationality Indian

Domicile State KARNATAKA Category GM

Bank Account Number 20255598918 Caste BRAHMIN

Account Holder Name NEHA KAKKERI Sub Caste BRAHMIN

Bank Branch Name STATE BANK OF INDIA, HIGH COURT CIRCUIT BRANCH,GLB Religion HINDU

Bank IFSC Code SBIN0015263

Communication Address

1-867/4/A/1 ANUGRAHA NEW JEWARGI ROAD NEAR HANUMAN TEMPLE VENKATESHWAR NAGAR KALABURAGI - 585102

Applicant's Program Details

Program & ProgramType M.B.A I YEAR

Regional Centre KALBURGI

Study Centre ANANYA DEGREE AND MSW COLLEGE KALABURGI - BA/BCOM

Medium of Instruction ENGLISH

Applicant's Subjects Details

OPTIONAL M.B.A
SKILL DEVELOPMENT SUBJECT COMMUNICATION SKILLS
Applicant's Other Details

Aadhaar Number 424951893254

Applicant Profession STUDENT

Applicant's Quota Details

Differently Abled No

Defence No

Rural No

Urban Yes

BPL(Womens Only) No

Kalyana Karnataka(HK) Yes

 KARNATAKA STATE OPEN UNIVERSITY
Mukthagangotri, Mysuru-570006

Applicant's Qualification Details

Qualification Board /University Year of Pass Register No

SSLC KSEEB 2012 20120195038

PUC PUC 2014 231565

BCOM GULBARGA UNIVERSITY 2020 91737995

Applicant's Processing fee payment details

Application No Course Payment Id Amount Paid Date

Applicant's Admission fee payment details

Application No Course Payment Id Amount Paid Date

20120339 M.B.A pay_GJcTAYJn0igpRx 18,500.00 31/12/2020 4:19:48PM

Declaration by the Applicant

I do hereby declare that information furnished is true and correct to the best of my knowledge and belief. I agree to
the Terms and Conditions for given in the University prospectus.

Signature of the Applicant

UNDERTAKING

I understand that it is my responsibility to note of the relevant regulations of the course for which I am admitted in this
University and to satisfy the requirements in full. I will abide by the rules of CONDUCT and DISCIPLINE imposed by the
University and abstains from practicing RAGGING in any form. Further, I declare that I shall be responsible if I fail to
satisfy any of the conditions. I understand that the University is at liberty to take such suitable action as it deems fit
against me in the event of not registering SATISFACTORY PROGRESS and possessing SATISFACTORY CONDUCT.

Date : Signature of the Applicant

Place : NEHA KAKKERI

For Office Use Only

Application No Roll Number Course Date of Admission

20120339 M.B.A I YEAR

Payment Date Payment Id Payment Fee Paid Fee in Rupees

Status Amount
31/12/2020 pay_GJcTAYJn0igpRx Success 18500.00 Rupees Eighteen Thousand Five Hundred Fifty Only.

Total Fee 18500.00 Rupees Eighteen Thousand Five Hundred Only.

Case Worker Superintendent Regional Director