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Admission Form

Karnataka State Open University


Manasagangothri, Mysore
Name : J VINOD KUMAR
2. Fathers Name : Jayantha Babu
3. Mothers Name : G C Chandra Prabha Mani
4. Gender : Male
5. Date Of Birth : 26/06/1984
6. Nationality : Indian
7. Religion : Hindu
8. Caste : Thigula
9. Category [SC/ST/OBC/GM] : GM
10. Place Of Birth : Bangalore
11. Mobile Number : 7795104800
12. E-Mail ID : reach.jvinodkumar@gmail.com
1.

Correspondence & Permanent Address:


Country : India
City : Bangalore
State : Karnataka
Pin : 560038
th
Address 1: No: 20, 4 Main, Sadananda Nagar,
Address 2: NGEF East Layout
13. Are you in Service (Yes/No):

14. Date of Joining:


15. Office Address:

Course Details :
16. Academic Year:
17. Course taken : MCA

Documents Attached:

Birth Certificate (10th marks card)(yes/No) : Yes


Degree (Convocation/all semester marks sheets) : Yes (Convocation)
Photos : Attached

Qualification Details:
18. Last Exam Passed: BSc
19. University: Bangalore
20. Reg. No: 02BWS01070
21. Year of Passing: 2005
22. Subjects: Physics, Chemistry, Mathematics
23. Class: Second
24. Marks Obtained:
25. Total Marks Obtained:
26. Percentage: 52.50
Declaration:
I clarify that all details furnished are correct to the best of my knowledge and belief, in
case of my information given being found to be false or any certificate submitted found
not genuine, I understand that I will lose my admission and all fees paid will be forfeited,
besides being open to other legal action.

Student signature / name as per 10th marks card: