Candidate's Details

Application Number :

100081

1 Course/s Applied for PGCET :

M B A & M C A & M.Tech/M.Arch

2 Name of the Candidate :

RAGHAVENDRA H

3 Name of the Father :

HANUMANTHAIAH

4 Name of the Mother :

PRAMILAMMA

5 Date of Birth :

03:09:1986

6 Gender :

Male

7 Quota :

Karnataka

8 Category :

Category-2A

9 Caste :

CA

Candidate's
photo

8 (a) Income RD Number (RD00-------)

RD0001

8 (b) Caste RD Number starting with (RD0--------)

10 Religion :

Hindu

12 Eligibility Clause Code:

11 Income :

13 Qualifying Degree / Engineering Branch ?

600000

B.E - COMPUTER SCIENCE ENGG

Program Type

FULL TIME

14 Do You Claim Reservation Under Physically Disabled Quota ?

Yes

15 Do You Claim Reservation Under Ex-Serviceman Quota ?

Yes

16 Do You Claim Reservation Under 371(J) (Hyderabad Karnataka) Quota ?

Yes

16 (a) 371(J) RD Number starting with (RD0--------)

RD02563

M.Tech Program Details (Only for M.tech Candidates)

PGCET Appearing under :

TYPE A

PGCET Exam Appearing Course Name :

Computer Science Eng

Have you Appeared for GATE during 2015 or 2016 ?

No

GATE Code :
GATE Score :

Do You Claim Seat under Sponsered Quota?

Yes

Do You Claim Seat under Quality Improvement Program ?

Yes

PGCET Examination Centre

GULBARGA (KALABURGI)

17. Study Information

Have You done BCA, BSc (I.T / Computer Science ) with Mathmatics at 10+2 level or at
Graduate Level ? (for Lateral entry to 2nd Year MCA )

Yes

Qualifying Exam Status ?

Appeard

University Seat No : (USN)

123654

Name of the Qualifying Exam

College :

VTU

Name of the University :

VTU

Total Number of Years of Study in Karnataka :

Particulars of
Examination

Result

15

Month of Passing

Year of Passing

Maximum Marks

Secured Marks

Pass

January

2013

1000

800

Pass

January

2014

1000

850

Pass

January

2015

1000

850

Pass

January

2016

1000

500

Candidate's Postal Address for Communication

Address :

ADDR,ADDR,ASDDRDODDABALLAPURA,BANGALORE RURAL(BENGALURU),KARNATAKA572022

Mobile No :

8958691236

Email :

sample@gmail.com

Declaration

I declare that the in formation furnished through online is true and correct to the best of my knowledge and belief. I 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 me is found to be false or incorrect, I shall forfeit the claim to be considered
or a seat selected and allotted by KEA. I am liable for civil and criminal action, that the State Government or the KEA may
take against me in this regard.

Signature of the
Candidate

Left Hand Thumb impression of

the Candidate

Date:

Principal / Gazetted Officer Signature

Name:
Signature:
Seal:

PAYMENT STATUS
Appno :

100081

NAME OF THE CANDIDATE :

RAGHAVENDRA H

APPLICATION FEES :

BANK NAME :

State Bank of Mysore

BANK

10

BANK Ref NUMBER :

888888888

CHARGES :

Printed Date

24-05-2016 03-40-59