SAAT : 2014

Application No.:614398

Program Detail Program Type : Post Graduate Course Code : (45) M.Tech. - Electrical Engineering Lateral Entry : No Test Centre : 1-(18)Bhubaneswar, 2-(20)Cuttack, 3-(25)Puri

Personal Detail Candidate Name : BIKASH RANJAN DASH Father Name : JITENDRA KUMAR DASH Mobile No: 8763724218 Identity Proof : Voter ID Card Nationality : Indian Email Id : DAShbikash34@gmail.com Resident State: Odisha STD Code : Identity Proof No : ZQZ0441915 Gender : Male Category : Gen Alternative Mobile No : 9437747401 Relation Ship : Father Date Of Birth : 18/02/1991 Phone No : Mother Toungue : Odia

Correspondence Address C/O Name : B.BISWAL House-No/Village : PLOT-3334,CHAKEISIHANI City : BHUBANESWAR Country : INDIA District : KHURDHA Pin Code : 751010 State : ODISHA Mobile No : 8763724218 Police Station : MANCHESWAR

Qualifying Detail 10th Exam Percentage : 47 Graduate Percentage : 72 Year Of Qualifying : 2012 Board Qualifying Exam : CHSE (State Board) Qualifying Exam : Passed Roll No./Reg.No. : 0801294334 Name Of School : G.C.D HIGH SCHOOL School Location : RAYAGADA Month &Year Of Passing/Appearing : 03/2006

SAAT : 2014

Application No.:614398

SAAT-2014

Name : B.BISWAL PLOT-3334,CHAKEISIHANI MANCHESWAR BHUBANESWAR KHURDHA Odisha INDIA PIN CODE :751010

MOBILE NO. : 8763724218

Voter ID Card:ZQZ0441915

DAShbikash34@gmail.com

Online Payment Details Order Id: 614398 Date : 20/02/2014 Transaction No : 2000002824 Amount : 500/Receipt No. : 405204566859

DECLARATION BY THE CANDIDATE

I here declare that all the particulars stated in this application are true to the best of my knowledge and belief. I have read the Information Brochure and I shall abide by the terms and conditions.In the event of suppression or distortion of any fact like suppressing like category or education qualification or nationality etc. made in my application form, I understand that I will be denied the opportunity to appear in SAAT-2014 and if already admitted, my admission /degree /degree acquired is liable for cancellation. I understand that the decision of the Siksha 'O' Anusandhan University Regarding my admission to engineering / Medical /Dental /Nursing /Pharmacy /Biotechnology /MBA /Hotel Management /MCA /Law is final and I shall abide by the decision.Further, if admitted, I Promise to abide by the rules and norms of discipline of the Siksha 'O' Anusandhan University.

Place : .............................................. Full Signature of Candidate Date : ..............................................

Name of Parent/Guardian (In Block Letters)

Full Signature By Parent/ Guardian

Send the Complete Application form to the following address: The Director (Admissions) Admission Cell, Siksha 'O' Anusandhan Deemed University Institute of Technical Education &Research Campus Jagamara, Post: Khandagiri, Bhubaneswar Odisha, India. Pin Code: 751030