Andhra Pradesh Residential Educational Institutions Society (Regd.

),
Hyderabad
Application for APRJC Common Entrance Test -2017

Personal Details
1 Reference Id : 3720007663
2 Surname : ADARI
3 Candidate Name : ADARI KUSUMA
4 Father Name : ADARI VENKATA APPARAO
5 Mother Name : ADARI KALYANI
6 Date of birth : 30/12/2001
7 Gender : Female
8 Address : 45-8-1/A JAGGARAO BRIDGE
GOLEELA STREET
AKKAYYAPALEM
Mandal : Visakhapatnam(U)
District : VISAKHAPATNAM
Pincode: 530016
9 e-Mail : adaripavankumar1999@gmail.com
10 Mobile : 9866122967
11 Reservation Category : BC-D
12 Medium of Study in Class X : ENGLISH
13 Category(General/Minority) : General
14 Group/Course Opted : BPC
15 Candidate desire Write Exam : ENGLISH / TELUGU
16 Mention District by Study/Nativity : VISAKHAPATNAM
17 Reservation under Sports : No
18 Reservation under CAP(Childern of Armed No
Personnel) :
19 Are you a Physically Handicapped(PH) No
Person :
Qualification Details
20 Board : BOARD OF SECONDARY EDUCATION,A.P
21 SSC Hallticket Number : 1738104362
22 Examination Center : VISAKHAPATNAM
23.Payment Details
Fee Amount Journal Number Payment Date
150 /- IUR25248343381 01/04/2017
I hereby declare that
I read the information bulletin of APRJC CET 2017 and found myself fully eligible to appear for the entrance test
as per the criteria mentioned in the bulletin.
I am appearing for Class X(2017) Public examinations as a fresh candidate(First attempt, not compartmental) and the
particulars furnished above are true to the best of my knowledge and belief.
Sd/-
ADARI KUSUMA
01-04-2017 02:09:05 PM