KARNATAKA STATE OPEN UNIVERSITY

Mukthagangotri, Mysuru-570006

Application Number : 20120367 Date : 31/12/2020

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

Applicant's Basic Details

Name MANGALA
Father/Husband/Guardian
Name SUBHASHCHANDRA DESHMUKH

Mother Name SUDHARANI

Email Id aarunkumarchavan83@gmail.com

Mobile 7411630876

Date of Birth 21/03/1994

Gender FEMALE

Nationality Indian

Domicile State KARNATAKA Category GM

Bank Account Number 11029101005969 Caste BRAHMIN

Account Holder Name MANGALA Sub Caste BRAHMIN

Bank Branch Name PRAGATHI KRISHNA GRAMIN BANK, CHITTAPUR Religion HINDU

Bank IFSC Code PKGB0011029

Communication Address

OLD GUNJ STATION ROAD CHITAPUR KALABURAGI - 585211

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 882169375647

Applicant Profession STUDENT

Applicant's Quota Details

Differently Abled No

Defence No

Rural Yes

Urban No

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 2011 20110206449

PUC PUC 2013 143142

BCA GULBARGA UNIVERSITY 2020 17811203

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

20120367 M.B.A pay_GJcVJ7HKtz9ASD 18,500.00 31/12/2020 4:21:37PM

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 : MANGALA

For Office Use Only

Application No Roll Number Course Date of Admission

20120367 M.B.A I YEAR

Payment Date Payment Id Payment Fee Paid Fee in Rupees

Status Amount
31/12/2020 pay_GJcVJ7HKtz9ASD 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