7/28/2019 Application 7005203pdf
1/1
APPLICATION FORM FOR ODISHA JOINT ENTRANCE EXAMINATION -
2013
Application No. : 7005203
01. Name of the Applicant
02. Mother's Name
03. Father's Name
Computer Science Engineering/Information Technology (24)
21. Left Hand Thumb impression 23. PHOTOGRAPH
24. Signature (within box) in running hand usingblack ink. (DO
NOT SIGN IN CAPITALS)
Name
Address
PIN Code
Telephone
SAPTARSHI RANJAN KHUNTIA
C/O:MAHESWAR KHUNTIA VIA:JAJPUR ROAD
RADHANAGAR PATANA SANKHACHILLA JAJPUR
ORISSA
9692329781
755015
22. ADDRESS:
25. DECLARATION BY THE APPLICANT
Application No. : 7005203
I hereby declare that all the above particulars stated in this
application are true to the best of my knowledge and belief.I have
read the Information Brochure (OJEE-2013) and I shall abide by the
terms and conditions therein. In the event of suppression
or distortion of any fact like suppressing category or
educational qualifications or nationality etc., made in
my application form, I understand that I will be denied the
opportunity to appear in the OJEE-2013 and if already
admitted, my admission/degree acquired is liable for
cancellation. I understand that the decision of the Govt. of Odisha
/ OJEE 2013
regarding my admission to first year in
PGAT(MTech,M.Tech(PT),M.Pharm, M.Arch is final and I shall abide
by
the decision. Further, if admitted, I promise to abide by the
rules and norms of discipline of the institute where I will
join.
Place : Signature of the Applicant Countersign by
Parent/Guardian
26. DETAILS OF TRANSACTION
You have successfully submitted Application On-Line. Kindly take
a printout of this page. Paste your recent photograph
and put your signature and get the signature of your
parent/Guardian in the appropriate boxes. Also put your left thumb
impression
at the appropriate box. This completed form must be sent by
REGISTERED/ SPEED POST to Chairman, OJEE-2013, JEE Cell ,
Gandamunda, Khandagiri, Bhubaneshwar-751030 (keep the postal
receipt for further reference) so as to reach on or before 5.00
pmof the last date of submission of application from.
Application No.
7005203
SAPTARSHI RANJAN KHUNTIA
04. Category
10. Course
05. Reservation
06. Nationality
09. Gender
07. Mother Tongue
08. Date of Birth
11. Choice of Exam Centres
20. Residence District
15. board of qualifying exam
19. Mobile Number (Last 10 digits)
18. Phone Number including STD code
14. Percentage of marks in qualifying exam
16. E -Mail
13. Name of Qualifying Exam
12.Year of Passing / Appearing in qualifying exam
17. Parents/Guardiance's Total annual income
Date :
RANGALATA SAHOO
MAHESWAR KHUNTIA
Odisha State (S)
General (GE)
07
INDIAN
07 1977
2004
Male
Others
68
University Inside Odisha
[email protected]
Rs.50,000- Rs. 1,50,000
9692329781
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
Odia (10)
Jajpur (13):
:
:
1st:Bhubaneswar (18), 2nd:Cuttack (22), 3rd:Berhampur (16)
:
Transaction ID/J.No.: 009822721
Bank Name : SBI
Fee Transaction Updated on : 16/03/2013
