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:

49202118147145

Online Application Form

I.General Details

Candidate Name : YESMITHAA R

ತಂದ Father Name/Guardian Name R RAJAGOPAL

Mother Name SHOBHA N

ಂ Date of Birth 05-11-2005

ಂ Mobile Number & Email 98XXXXXX52 - y****2@g****l.com

Candidate Nationality INDIAN - Resident of India

ಂ Candidate Gender FEMALE

Candidate Address NO.23, 2ND FLOOR, FIRST MAIN ROAD, BRR LAYOUT,
BANASWADI MAIN ROAD, BENGALURU NORTH,
BENGALURU URBAN, KARNATAKA - 560043
Caste Reservation Claimed / Income Details

Religion HINDU

Reservation category - 3A - VOKKALIGA

Name of the Caste

ತ ಂ RD0038115319772
Caste Certificate RD Number
ದ ತ ಂ Income Certificate RD
Number
Annual Income 120000

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: 25-02-2024 06-33-35 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:

49202118147145
NRI-WARD NO

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

ತೃ ಭ ಷ Mother Tongue KANNADA

Do you write/appearing Board Exam of 12th in Karanataka? Yes
ಂ ಂ ತ 7
Total number of years of study in Karnataka (From 1st to 12th Std.)
ಂ CBSE IN KARNATAKA
State of 2nd PUC / 12th/ Equivalent exam & Qualifying Examination Board
College Type PRIVATE
ಂ CBSE IN KARNATAKA
State of 2nd PUC / 12th/ Equivalent exam & Qualifying Examination Board
District of 2nd PUC/12th/Equivalent exam (if studied in karnatka) BENGALURU URBAN
ದ ಂ PUC Student Number & Year of 18602628 - 2023-
Passing
ಂ NO - 202118147145

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

Number
ಂತ ಂ YES BK022 2023

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)
UG - Para Medical Courses(BPO/BPT & AHS)
UG Architecture (NATA)

Exam Ceners
Exam Center (Priority 1) BENGALURU NORTH
Exam Center (Priority 2) BENGALURU SOUTH

Printed Date: 25-02-2024 06-33-35 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:

49202118147145
Study Details
ಂ

Name and Address of the District ತ Passed Passed Board Area Medium
School and Address Class Year
NARAYANA OLYMPIAD BENGALURU 6 2016 CBSE in - -
SCHOOL, KASTURI NORTH Karnataka
NAGAR,BENNIGANAHALLIKa
sturi nagar
NARAYANA OLYMPIAD BENGALURU 7 2017 CBSE in - -
SCHOOL, KASTURI NORTH Karnataka
NAGAR,BENNIGANAHALLIKa
sturi nagar
NARAYANA OLYMPIAD BENGALURU 8 2018 CBSE in - -
SCHOOL, KASTURI NORTH Karnataka
NAGAR,BENNIGANAHALLIKa
sturi nagar
NARAYANA OLYMPIAD BENGALURU 9 2019 CBSE in - -
SCHOOL, KASTURI NORTH Karnataka
NAGAR,BENNIGANAHALLIKa
sturi nagar
NARAYANA OLYMPIAD BENGALURU 10 2020 CBSE in - -
SCHOOL, KASTURI NORTH Karnataka
NAGAR,BENNIGANAHALLIKa
sturi nagar
NARAYANA E-TECHNO BENGALURU 11 2021 CBSE in - -
SCHOOL MANDUR,mandur SOUTH Karnataka
village, virgo nagar post,
bangalore-560049
NARAYANA E-TECHNO BENGALURU 12 2023 CBSE in - -
SCHOOL MANDUR,mandur SOUTH Karnataka
village, virgo nagar post,
bangalore-560049
Bank Details
Account Holder N Shobha Bank Name IDBI Bank
Name
IFSC Code IBKL0001620 Bank Branch Banaswadi
Account Number 1620XXXXXX112161

Payment Details
AppNo 49202118147145 Bank Ref No. YHMP2226595157

Printed Date: 25-02-2024 06-33-35 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:

49202118147145
Application Fee Rs. 600 Bank Name Bill desk
Paid Date 06/02/2024

Uploaded Documents List

SSLC/10th standard Marks Card or equivalent Certificate
Caste/Income Certificate (For SC/ST in Form-D, Cat-1 in Form-E and 2A, 2B, 3A & 3B in Form-
F Issued by the concerned Tahsildar of Karnataka)
Passport Size Photo
Thumb Photo
Signature
Class 6 Study Certificate
Class 7 Study Certificate
Class 8 Study Certificate
Class 9 Study Certificate
Class 10 Study Certificate

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: 25-02-2024 06-33-35 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:

49202118147145

Left hand Thumb of

Signature of the
Candidate
Candidate

Printed Date: 25-02-2024 06-33-35 Page No: 5