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9/15/2018 Application Form

KARNATAKA STATE ELIGIBILITY TEST (KSET) FOR LECTURESHIP


DECEMBER - 2018
Print copy of Application Form
(ONE COPY TO BE SUBMITTED TO THE NODAL OFFICER OF THE TEST CENTER)

To be Filled by the Test Center Only

Roll No.: 14100011

Ref No.: 9958

Prof. J. K. Raju
Nodal Officer, KSET
Department of Business Administration,
Tolahunase, Davanagere University,
Shivagangothri, Davanagere - 577 002.

Subject Code: 10
Center Code: 14
Category: ST

Personal Information Affix recent


Passport size
1. Name : SMITHA K B Photograph signed
by the candidate
2. Date of Birth : 19-Jul-1992
and duly attested
3. Age as on (31-07-2018) : 26 years, 0 month, 12 day by the Head of the
4. Sex : Female Dept./Institution or
5. Category : ST Class I Gezetted
Officer.
6. Visually handicapped
: NO
(VH) (DO NOT STAPLE
7. Physically handicapped OR PIN)
: NO
(PH)
8. Father's Name : BASAVANNEPPA
9. Mother's Name : SHASHIKALA
10. Address for : #567/31,32, Saraswathi nagar 'B' Block,Behind Church, Nittuvalli,
Communication Davanagere- 577004
: #567/31,32, Saraswathi nagar 'B' Block, Behind Church, Nittuvalli,
11. Permanent Address
Davanagere- 577004
12. Post Graduation
: Passed
Examination
13. Subject of Post-
: Management - Finance
Graduation
14. Subject opted for KSET : Management
15. Center of Examination
: Davanagere - Davanagere University,
selected
16. Examination Appearing
: Passed
/ Passed
17. Name of the University : Davanagere University
18. Year of Passing : 2016
19. Subject Offered : Management - Finance
20. Marks obtained : 6.15
21. Total Marks : 10
22. Aggregate % of marks
: 61.5
obtained
23. Mobile No. : 9538525410
24. Email ID : smithakb.kb@gmail.com

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9/15/2018 Application Form

Details of Fee Paid

26. Payment Mode : SBDEBIT


27. Bank Reference No. : DU98999211
28. Deposit Date : 11-Sep-2018
29. Amount : Rs. 550

Declaration

i. I, SMITHA K B, applicant for KSET - 2018, hereby declare that all statement made in this application are true,
complete and correct to the best of my knowledge and belief and in the event of any information being found false or
incorrect or any ineligibility being detected before or after the test, my candidature is liable to be cancelled and legal
action may be initiated against me.
ii. I fullfill all the conditions of eligibility regarding age limit, educational qualification etc. prescribed for the test.
iii. I have gone through the Notification of KSET - 2018 and shall abide by the same.
iv. I have deposited the required fee.
v. I have noted that if my application is found incomplete / defective, the same is liable to be rejected summarily and
no correspondence will be entertained in this regard.
vi. I have read and agree with the Notification for the KSET - 2018, including instructions, enclosures, check list and
other relevant information.

Place: Davanagere
Date: 11-Sep-2018 Signature of Candidate _______________________

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