Candidate's Details

Application Number : 418403

1 Course/s Applied for PGCET : MBA & M.Tech/M.Arch(only)

2 Name of the Candidate : MOHAMMED ARSALAN

3 Name of the Father : NISAR AHMED
4 Name of the Mother : SHAHEEDA BEGUM
5 Date of Birth : 19:12:1995
6 Gender : Male 7 Quota : Non Karnataka
8 Category : 9 Caste :
8 (a) Income RD Number (RD00-------)
8 (b) Caste RD Number starting with (RD0--------)

10 Religion : 11 Income :
12 Eligibility Clause Code:
13 Qualifying Degree / Engineering Branch ?
Program Type FULL TIME
14 Do You Claim Reservation Under Physically Disabled Quota ?
15 Do You Claim Reservation Under Ex-Serviceman Quota ?
16 Do You Claim Reservation Under 371(J) (Hyderabad Karnataka) Quota ?
16 (a) 371(J) RD Number starting with (RD0--------)

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

PGCET Appearing under :
PGCET Exam Appearing Course Name :
Have you Appeared for GATE during 2016 or 2017 ?
GATE Code :
GATE Score :
Do You Claim Seat under Sponsered Quota?
Do You Claim Seat under Quality Improvement Program ?
PGCET Examination Centre

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 )
Qualifying Exam Status ? Appeard University Seat No : (USN)
Name of the Qualifying Exam Name of the University :
College :
Total Number of Years of Study in Karnataka :
Particulars of Result Month of Passing Year of Passing Maximum Marks Secured Marks
Examination
1 Pass July 2014 1150 992

Candidate's Postal Address for Communication

Address :
Mobile No : 7204130690
Email : Sallu.mandya@yahoo.com

Declaration
 I declare that the information 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 Left Hand Thumb impression of Date:

Candidate the Candidate

Principal / Gazetted Officer Signature

Name:
Signature:

Seal:

PAYMENT STATUS
APPLICATION FEES : BANK NAME :
BANK CHARGES : BANK Ref NUMBER :
Printed Date 28-05-2017 05-59-57