Common Application Form

Common PG Entrance Test, Academic Session (2024-25)

Higher Education Department, Government of Odisha 24P0485457
Thursday, May 23, 2024 5:54:37 PM

Personal Details

Applicant's Name : BIPASHA MOHANTY

Father's Name : RAMANI KANTA MOHANTY

Mother's Name : SABITA MOHANTY

Blood Group : B+ Gender : FEMALE

Religion : HINDU Date of Birth : 21-Jun-2003

Identification Type : AADHAAR Identification No : ********9136

State of Domicile : ODISHA APAAR ID : 427022204812

Address for Correspondence

Details(Plot/Flat/Building/Village) : WARD NO-8,KARANJIA Block / ULB : KARANJIA (NAC)

District : MAYURBHANJ State : ODISHA

PIN Code : 757037 Mobile No. : 7735703350

Whatsapp No. : 7735703350 Alternative Mobile No. : 8658595805

e-Mail : m.bipasha2003@gmail.com Residence Certificate Barcode : NOT PROVIDED

Issuing Authority : NOT PROVIDED Issuing Date : NOT PROVIDED

Reservation Details

Social Category : GENERAL PWD : NO

Sub Category : NONE Applicant's welfare Classification : Child with Biological Parents

Weightage Details

NCC : NA NSS : NA

Rover & Ranger : NA Sports & Games : NA

Graduation Examination : APPEARED

Educational Qualification

+2 Equivalent/Stream : ARTS

Name Of The Examination Stream Mark Board / University Year Of Roll Max Marks / Secured Marks / %
/ Class Type Passing No. CGPA CGPA Secured

GRADUATION/EQUIVALENT ARTS CGPA MAHARAJA SRIRAM CHANDRA 2024

BHANJADEO UNIVERSITY

Note: If you have entered incorrect details (not having at least 24 credits but mentioned the same), your candidature will be cancelled during admission and document
verification process.

Graduation Subject

Passed Graduation With ? : HONOURS

Core/Hons/Major : ENGLISH Credit : 84

1st Sem Generic Elective : NA Credit : NA

 2nd Sem Generic Elective : NA Credit : NA

3rd Sem Generic Elective : NA Credit : NA

4th Sem Generic Elective : NA Credit : NA

Subject For PG Entrance Examination

SL# Subject

1 ENGLISH

Preference Of Examination Zone

BALASORE

Payment Details

Payment Date Payment Amount Transaction Number Payment Mode Payment Through

23-May-2024 500.00 414487864602 UPI SBIEPAY

Bank Account Details

Account Number : 39063242213 IFSC Code : SBIN0001081

MICR Code : 757002507 Bank Name : STATE BANK OF INDIA

Branch Name : KARANJIA

Income details

Mother's
Father's Occupation : GOVT.SERVICE HOME MAKER
Occupation :

Annual Income of the

2.5 to 8.0 lakh Actual Income : 500000.00
parents(together) in Rs. :

To Whom the
Income Certificate Barcode : NOT PROVIDED Certificate is NOT PROVIDED
Issued :

Issuing Authority : NOT PROVIDED Issuing Date : NOT PROVIDED

Other Information

Special Category (For GSSY Scholarship) : None of these

Does your parents qualify as beneficiaries for KALIA Yojana? : No

Does your parents hold a Labour card? : No

* You are Provisionally Eligible for following Scholarship Scheme.

Scholarship Scheme

SL# Scholarship Name

1 Vyasakabi Fakirmohan Bhasabruti

2 NUA-O Scholarship

Declaration
I BIPASHA MOHANTY ,solemnly affirm that the information furnished above is true and correct in all respect to the best of my knowledge and
belief. I have not concealed any information. I undertake that if any information herein is found to be incorrect or false, I shall be liable for action as
per rules in force.

Date:

Place: Signature of Applicant

5/23/2024 5:54:37 PM