Application Number : 1130851 Course/s Applied for PGCET 2015 :

M B A (only)

2 Name of the Candidate : SHRUTHI N SHETTY3 Name of the Father : LATE NARAYAN K SHETTY4 Name of the Mother : SHRIMATHI N SHETTY5 Date of Birth : 15:09:1994

Candidate's Details

6 Gender : Female 7 Quota : Karnataka8 Category : Category-3B 9 Caste : BUNTS

10 Religion : Hindu 11 Income : 2000012 Eligibility Clause Code: a

13 Qualifying Degree / Engineering Branch ? B.Com (3 Years Degree) Program Type FULL TIME14 Do You Claim Reservation Under Physically Disabled Quota ? No15 Do You Claim Reservation Under Ex-Serviceman Quota ? No16 Do You Claim Reservation Under 371(J) (Hyderabad Karnataka) Quota ? No

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 )

No

Qualifying Exam Status ? Completed University Seat No : (USN) 125481514 Name of the Qualifying Exam College :

ST ALOYSIUS COLLEGE Name of the University : MANGALORE

Total Number of Years of Study in Karnataka : 16

Particulars of Examination

Result Month of Passing Year of Passing Maximum Marks Secured Marks

1 Pass May 2013 100 67

2 Pass May 2014 100 71.87

3 Pass May 2015 100 64.133

Candidate's Postal Address for CommunicationAddress : SHREE DURGA PRASAD APARTMENT,OPP IDEAL TRADERS ALLAGUDDA ,KODIKAL

MANGALOREMANGALORE,DAKSHINA KANNADA(MANGALURU),KARNATAKA-575006Mobile No : 9731249061

Email : shruthishettyn1@gmail.com

Declaration

Signature of the Candidate

Left Hand Thumb impression of the Candidate

Date:

I declare that the in formation 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.

M.Tech Program Details (Only for M.tech Candidates)PGCET Appearing under :

PGCET Exam Appearing Course Name :Have you Appeared for GATE during 2014 or 2015 ? No GATE Code :GATE Score : 0Do You Claim Seat under Sponsered Quota? No Do You Claim Seat under Quality Improvement Program ? No

PGCET 2015 Examination Centre MANGALORE(MANGALURU)

PAYMENT STATUSAppno : 113085 NAME OF THE CANDIDATE : SHRUTHI N SHETTYAPPLICATION FEES : 660 BANK NAME : State Bank of MysoreBANK CHARGES : 10 BANK Ref NUMBER : 40149000370960100715

Printed Date 12-07-2015 09-04-35

Name:

Signature:

Seal:

Principal / Gazetted Officer Signature