ODISHA UNIVERSITY OF AGRICULTURE & TECHNOLOGY

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

Applicant Details

Applicant Name AYUSH PRADHAN Application No. ACK01007040

Mother's Name JANAKI PRADHAN Father's Name JADUMANI PRADHAN
Date of Birth 03/06/2006 (Age as on 31.12.2024) 18 Years 6 Months 28 Days
Gender Male Religion Hindu
Blood Group A+ Parents Annual Income Below 1 Lakhs
Category UR Mother Tongue Odia
Nationality INDIAN Email ayushpradhan1099@gmail.com
Mobile Number 9348373466 Alt. Mobile No. 9777337505

Present Address Permanent Address

Address AT/PO. - KAMGAON PS.- BHATLI TEHSIL- BHATLI DIST.- Address AT/PO. - KAMGAON PS.- BHATLI TEHSIL- BHATLI DIST.-
BARGARH BARGARH
District Bargarh District Bargarh
State Odisha State Odisha
Country India Country India
Zip 768038 Zip 768038
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 Baragarh Second Choice Sambalpur Third Choice Bhubaneswar

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
14/03/2024 TXOUAUG140320240094731 RTOUAUG140320240078230 1500.00 Payment Successful.

Declaration
I, AYUSH PRADHAN 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