Bal Gangha Dhaar Tilka
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Form No- OL13-1020-006640
POST-GRADUATE TEACHING DEPARTMENTS VANI VIHAR, BHUBANESWAR-751004 ONLINE APPLICATION FORM FOR ADMISSION
FOR MASTERS PROGRAMS
Utkal University
Close
Name of the Course: Physics
For office use only
Index No: Career Mark: Entrance Test Marks: Total marks : Head of Department:
Date of Admission: Verifying Officer: Roll No: Position in the list: Admission in Charge:
Applicant details :
Applicant's Name : Father's/Guardian Name: Nationality : Mother Tongue : Email :
PREETI POONAM BEBARTA KRUSHNA CHANDRA BEBARTA Indian Odia poonambebarta@gmail.com
Gender : Date Of Birth : Religion : Martial status :
FEMALE 27-04-1993 HINDU NO
Present Address :
C/o : Addr Line 1 : Addr Line 2 : PIN :
KRUSHNA CHANDRA BEBARTA AT-119 COLONY PO/DISTMALKANGIRI 764048 Contact No : 9439272708
Permanent Address :
C/o : Addr Line 1 : Addr Line 2 : PIN :
KRUSHNA CHANDRA BEBARTA AT-119 COLONY PO/DISTMALKANGIRI 764048 Contact No : 9439272708
Payment :
SL.No Amount 1. 2. 150 350
Demand Draft 493209 493208
DATE 19-06-2013 19-06-2013
BANK STATE BANK OF INDIA STATE BANK OF INDIA
Reservation Details :
eadmission.utkaluniversity.ac.in/modules/form/print.php
1/3
Caste: Physically handicapped: Children Of Ex-Serviceman: Represent country in international sports: Representing State at National Level Sports during last 3 years:
General Category Candidate NO NO NO NO
Serving Defence Personal: Children of Martyrs: Domicile of odisha living in outside state: Odia living in neighbouring state: Representing University at Inter-University sports during last 3 years:
NO NO NO NO NO
Other University details :
Hostel Accommodation: Whether Admitted/Passed/Completed any other PG Courses: Whether admitted to any other course : University : College :
YES NO
Utkal University Registration No:
NO Course :
Criminal antecedents/Criminal Cases : Whether Employed : Name of the organisation
Form No- OL13-1020-006640
POST-GRADUATE TEACHING DEPARTMENTS VANI VIHAR, BHUBANESWAR-751004 ONLINE APPLICATION FORM FOR ADMISSION
FOR MASTERS PROGRAMS
Utkal University
Close
Name of the Course: Physics
For office use only
Index No: Career Mark: Entrance Test Marks: Total marks : Head of Department:
Date of Admission: Verifying Officer: Roll No: Position in the list: Admission in Charge:
Applicant details :
Applicant's Name : Father's/Guardian Name: Nationality : Mother Tongue : Email :
PREETI POONAM BEBARTA KRUSHNA CHANDRA BEBARTA Indian Odia poonambebarta@gmail.com
Gender : Date Of Birth : Religion : Martial status :
FEMALE 27-04-1993 HINDU NO
Present Address :
C/o : Addr Line 1 : Addr Line 2 : PIN :
KRUSHNA CHANDRA BEBARTA AT-119 COLONY PO/DISTMALKANGIRI 764048 Contact No : 9439272708
Permanent Address :
C/o : Addr Line 1 : Addr Line 2 : PIN :
KRUSHNA CHANDRA BEBARTA AT-119 COLONY PO/DISTMALKANGIRI 764048 Contact No : 9439272708
Payment :
SL.No Amount 1. 2. 150 350
Demand Draft 493209 493208
DATE 19-06-2013 19-06-2013
BANK STATE BANK OF INDIA STATE BANK OF INDIA
Reservation Details :
eadmission.utkaluniversity.ac.in/modules/form/print.php
1/3
Caste: Physically handicapped: Children Of Ex-Serviceman: Represent country in international sports: Representing State at National Level Sports during last 3 years:
General Category Candidate NO NO NO NO
Serving Defence Personal: Children of Martyrs: Domicile of odisha living in outside state: Odia living in neighbouring state: Representing University at Inter-University sports during last 3 years:
NO NO NO NO NO
Other University details :
Hostel Accommodation: Whether Admitted/Passed/Completed any other PG Courses: Whether admitted to any other course : University : College :
YES NO
Utkal University Registration No:
NO Course :
Criminal antecedents/Criminal Cases : Whether Employed : Name of the organisation