Government of Karnataka

Karnataka Examinations Authority

PGCET Online Application - 2024
PGCET 2024

2024-25 MCA,MBA,M.Tech,M.Arch
Online Application for MCA,MBA,M.Tech,M.Arch courses for the Year 2024-25

Final Copy Appln No:

3920190278645

Applied Courses : MBA

Online Application Form

I.General Details

Candidate Name : SRIRAM BALDWA

ತಂದ Father Name/Guardian Name SRIKANT BALDWA

Mother Name KIRAN BALDWA

ಂ Date of Birth 24-12-2003

ಂ Mobile Number & Email 88XXXXXX90 - s****8@g****l.com

Candidate Nationality INDIAN - Resident of India

ಂ Candidate Gender MALE

Candidate Address IB COLONY 1-4-89/7, RAICHUR, RAICHUR,

KARNATAKA - 584101
Caste Reservation Claimed / Income Details

Religion HINDU

Reservation category - GM -
Name of the Caste

ತ ಂ
Caste Certificate RD Number
ದ ತ ಂ Income Certificate RD
Number
Annual Income

Academic Details
Quota claimed / ತ Eligibility Clause Code - CLAUSE - A

ತೃ ಭ ಷ Mother Tongue OTHERS

ಂ 15
Total number of years of study in Karnataka
Studied Mathematics in 10+2 or Degree N

Printed Date: 14-06-2024 09-03-07 Page No: 1

 Government of Karnataka
Karnataka Examinations Authority
PGCET Online Application - 2024
PGCET 2024

2024-25 MCA,MBA,M.Tech,M.Arch
Online Application for MCA,MBA,M.Tech,M.Arch courses for the Year 2024-25

Final Copy Appln No:

3920190278645
Degree Qualificaiton Details

Degree Regno Degree Pass Degree Qualification Degree Qualification Stream

Year
U23AP21M0011 2024 3 Years Degree BBA(3 Yrs) - Administration Degree
College Name College Address University Name
Sri Venkateshwara Degrree College GDS COMPLEX, IB ROAD, Raichur University
INDIRA NAGAR, RAICHUR 584101
, RAICHUR , RAICHUR ,
KARNATAKA

Exam Ceners
Exam Center (Priority 1) KALABURGI (GULBARGA)
Exam Center (Priority 2) BALLARI (BELLARY)

Study Details
ಂ

Name and Address of the District ತ Passed Passed Board Area Medium
School and Address Class Year
S.R. SUKHANI CO-EDN HIGH RAICHUR 1 2010 KARNATA - -
SCH.WARD 3 raichur WARD 3 KA (
raichur STATE
BOARD )
S.R. SUKHANI CO-EDN HIGH RAICHUR 2 2011 KARNATA - -
SCH.WARD 3 raichur WARD 3 KA (
raichur STATE
BOARD )
S.R. SUKHANI CO-EDN HIGH RAICHUR 3 2012 KARNATA - -
SCH.WARD 3 raichur WARD 3 KA (
raichur STATE
BOARD )
S.R. SUKHANI CO-EDN HIGH RAICHUR 4 2013 KARNATA - -
SCHOOL WARD NO. 3 KA (
RAICHUR-584101 STATE
BOARD )
S.R. SUKHANI CO-EDN HIGH RAICHUR 5 2014 KARNATA - -
SCHOOL WARD NO. 3 KA (
RAICHUR-584101 STATE
BOARD )
S.R. SUKHANI CO-EDN HIGH RAICHUR 6 2015 KARNATA - -
SCHOOL WARD NO. 3 KA (
RAICHUR-584101 STATE
BOARD )

Printed Date: 14-06-2024 09-03-07 Page No: 2

 Government of Karnataka
Karnataka Examinations Authority
PGCET Online Application - 2024
PGCET 2024

2024-25 MCA,MBA,M.Tech,M.Arch
Online Application for MCA,MBA,M.Tech,M.Arch courses for the Year 2024-25

Final Copy Appln No:

3920190278645
S.R. SUKHANI CO-EDN HIGH RAICHUR 7 2016 State URBA English
SCH.WARD 3 raichur WARD 3 N
raichur
S.R. SUKHANI CO-EDN HIGH RAICHUR 8 2017 State URBA English
SCH.WARD 3 raichur WARD 3 N
raichur
S.R. SUKHANI CO-EDN HIGH RAICHUR 9 2018 State URBA English
SCH.WARD 3 raichur WARD 3 N
raichur
S.R. SUKHANI CO-EDN HIGH RAICHUR 10 2019 State URBA English
SCH.WARD 3 raichur WARD 3 N
raichur
Seth Rikabhchand Parasmal RAICHUR 11 / 1st PUC 2020 KARNATA - -
Sukhani pre-university college KA (
for STATE
arts,commerce,science,LVD BOARD )
college campus,raichur-
584101
POORNIMA PU RAICHUR 12 / 2nd PUC 2021 STATE URBA -
COLLEGEANUSHA N
PATILNAGAR RAICHUR
584101 OPP NAVODAYA
MEDICAL COLLEGE
RAICHUR 584103
sri venkateshwara degree RAICHUR 1st Year 2022 KARNATA - -
college raichur Degree KA (
STATE
BOARD )
sri venkateshwara degree RAICHUR 2nd Year 2023 KARNATA - -
college raichur Degree KA (
STATE
BOARD )
sri venkateshwara degree RAICHUR 3rd Year 2024 KARNATA - -
college raichur Degree KA (
STATE
BOARD )

Bank Details
Account Holder SRIRAM BALDWA Bank Name UNION BANK OF INDIA
Name
IFSC Code UBIN0575372 Bank Branch RAICHUR
Account Number 75XXXXXXXXX2998

Payment Details
AppNo 3920190278645 Bank Ref No. ZHD52072044937

Printed Date: 14-06-2024 09-03-07 Page No: 3

 Government of Karnataka
Karnataka Examinations Authority
PGCET Online Application - 2024
PGCET 2024

2024-25 MCA,MBA,M.Tech,M.Arch
Online Application for MCA,MBA,M.Tech,M.Arch courses for the Year 2024-25

Final Copy Appln No:

3920190278645
Application Fee Rs. 650 Bank Name Bill desk
Paid Date 14/06/2024

Uploaded Documents List

SSLC/10th standard Marks Card
2nd PUC/12th standard/Diploma Marks Card of the candidate
Candidate's Study Certificate
QE (Degree) marks cards of the candidate
Passport Size Photo
Thumb Photo
Signature
Class 1 Study Certificate
Class 2 Study Certificate
Class 3 Study Certificate
Class 4 Study Certificate
Class 5 Study Certificate
Class 6 Study Certificate

1 ಂ ಂತ ಂ ಂ ದ ಂ ಂ

2 ಂ ತ ದ ತ ತ
ದ ಂದ ಂ ಂತ ದ
NOTE : 1. After completion of all the process the candidates are required to take final print out of the Online Application
Form and submit the same during Document Verification.
2. The CASTE and INCOME certificate to be produced by candidates during seat selection process should have the
same CASTE and INCOME, as mentioned in this Application Form. No change in Caste / Category will be
permitted after the final declaration.

Declaration

Printed Date: 14-06-2024 09-03-07 Page No: 4

 Government of Karnataka
Karnataka Examinations Authority
PGCET Online Application - 2024
PGCET 2024

2024-25 MCA,MBA,M.Tech,M.Arch
Online Application for MCA,MBA,M.Tech,M.Arch courses for the Year 2024-25

Final Copy Appln No:

3920190278645
ಂತ ತ ಂ
ತಂ ಂ ಂ ಂ
ತಂ ಂ ಂ ಂತ ದ
ತ ತ ಂ ಂ ಂ ಂ ಂ ದ

We declare that the information furnished through online is true and correct to the best of our knowledge and
belief. We 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 us is found to be false or incorrect, We are
also liable for action, that the State Government or the KEA may take against us in this regard.

Left hand Thumb of

Candidate Signature of the
Candidate

Printed Date: 14-06-2024 09-03-07 Page No: 5