Andhra Pradesh Residential Educational Institutions Society (Regd.

),
Hyderabad
Application for APRJC Common Entrance Test -2016

Personal Details
1 Reference Id : 6610000134
2 Surname : KALLA
3 Candidate Name : KALLA KARTHIK
4 Father Name : KALLA SRINIVAS RAO
5 Mother Name : KALLA SRIDEVI
6 Date of birth : 5/11/2001
7 Gender : Male
8 Address : DNO 45-40-28A, 80FEETROAD,
BACKSIDE OF MAHARANIPARLOUR,
AKKAYYAPALEM, VISAKHAPATNAM
Mandal : Visakhapatnam(U)
District : VISAKHAPATNAM
Pincode: 530016
9 e-Mail : ksnivas_srinivas@yahoo.co.in
10 Mobile : 9440608778
11 Reservation Category : BC-D
12 Medium of Study in Class X : ENGLISH
13 Category(General/Minority) : General
14 Group/Course Opted : MEC
15 Mention District by Study/Nativity : VISAKHAPATNAM
16 Reservation under Sports : No
17 Reservation under CAP(Childern of Armed No
Personnel) :
18 Are you a Physically Handicapped(PH) No
Person :
Qualification Details
19 Board : BOARD OF SECONDARY EDUCATION,A.P
20 SSC Hallticket Number : 1638102814
21 Examination Center : VISAKHAPATNAM
22.Payment Details
Fee Amount Journal Number Payment Date
150 /- FICI4364265170 18/03/2016
23.College Preference Details
Preference 1 : APRJC Nagarjunasagar(Guntur Dt)
Preference 2 : APRJC Nimmakuru( krishna Dt)
Preference 3 : APRJC Venkatagiri(Nellore Dt)
I hereby declare that
I read the information bulletin of APRJC CET 2016 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(2016) 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/-
KALLA KARTHIK
18-03-2016 10:11:22 PM