Candidate's Details

Application Number :

130547

1 Course/s Applied for PGCET 2015 M.Tech/M.Arch (only)

:
2 Name of the Candidate :

RAGHUNATH KULKARNI

3 Name of the Father :

JAGANNATH KULKARNI

4 Name of the Mother :

SUMA KULKARNI

5 Date of Birth :

22:06:1993

6 Gender :

Male

7 Quota :

Karnataka

8 Category :

General Merit

9 Caste :

BRAHMIN

10 Religion :

Hindu

11 Income :

320000

12 Eligibility Clause Code:

13 Qualifying Degree / Engineering Branch ?

B.E - ELECTRONICS AND COMMUNICATION ENGG

Program Type

FULL TIME

14 Do You Claim Reservation Under Physically Disabled Quota ?

No

15 Do You Claim Reservation Under Ex-Serviceman Quota ?

No

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

Yes

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

PGCET Appearing under :

TYPE A

PGCET Exam Appearing Course Name :

Electrical Science

Have you Appeared for GATE during 2014 or 2015 ?

No

GATE Code :
GATE Score :

Do You Claim Seat under Sponsered Quota?

No

Do You Claim Seat under Quality Improvement Program ?

No

PGCET 2015 Examination Centre

BELLARY (BALLARI)

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 )

No

Qualifying Exam Status ?

Completed

University Seat No : (USN)

2BV11EC073

Name of the Qualifying Exam

College :

B.V BHOOMARADDI
COLLEGE

Name of the University :

VISVESVARAYA
TECHNOLOGICAL UNIVERSITY

Total Number of Years of Study in Karnataka :

Particulars of
Examination

Result

16

Month of Passing

Year of Passing

Maximum Marks

Secured Marks

Pass

June

2012

100

68.9

Pass

June

2013

100

67.9

Pass

June

2014

100

68.2

Candidate's Postal Address for Communication

Address :

RAGHUNATH KULKARNI ,H NO: 444, OPP KULLAYAPPA BUILDING, JOSHI COMPOUND,PATEL

NAGAR, HOSPETHOSPET(HOSAPETE),BELLARY(BALLARI),KARNATAKA-583201

Mobile No :

7204139039

Email :

raghunathkulkarni62@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
APPLICATION FEES :

BANK NAME :

BANK CHARGES :

BANK Ref NUMBER :

Printed Date

18-07-2015 12-32-38