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1. (a) Qualifying Degree Examination : ANY BACHELOR DEGREE OF 3/4/5 YEARS DURATION Preserve the Registration Number for
(b) Qualifying Degree Exam Hall Ticket No # : 2210427 all future correspondence.
(c) Year of App./Passing the Qualifying Exam : 2023 REGISTRATION NO. : 5310192127
(d) Medium of Instruction at Qualifying Exam : English
(e) Place of Study - Intermediate or Equivalent : Urban
2. (a) Candidate's Name # : SANTHOSH GAVIREDDY
(b) Father's Name # : GOPI GAVIREDDY
(c) Mother's Name : VARA LAKSHMI GAVIREDDY
(d) Date of Birth (as per SSC or Equivalent) # : 11/06/2003
(e) Gender : MALE
3. Category : BC_D
4. Local Area : AU
5. (a) Non-Minority / Minority : Non-Minority
(b) Minority Category : N.A
6. Annual Income of the Parents (Rs.) : Below Rs 1 Lakh
7. (a) Study Details :
Class 9 Kakinada Class 10 Kakinada
Inter 1st year/Equivalent Kakinada Inter 2nd year/Equivalent Kakinada
Degree 1st year Kakinada Degree 2nd year Kakinada
Degree 3rd year Kakinada
(b) Place of Study - SSC or Equivalent : Urban
(c) SSC Hall Ticket Number & Year of Passing : 1808103182 , March - 2018
(d) Inter Hall Ticket Number & Year of Passing : 2003219613 , March - 2020
8. (a) Address for Correspondence : 17-2-59/397, GANESH COLONY,2ND STREET, SANJAY
NAGAR,
KAKINADA, Kakinada,
ANDHRA PRADESH, 533001
(b) Contact Telephone Number (Mobile) : 6309645577 (c) E-Mail Id : santhoshj10419@gmail.com
(d) Aadhar Card number : 292160873947
9. Test Centre Preferences
Preference - 1 Preference - 2 Preference - 3
KAKINADA - Kakinada EAST GODAVARI - Rajahmundry VISAKHAPATNAM - Visakhapatnam
10. (a) Fee particulars - Payment through : ONLINE (c) Amount (in Rs.) : 614.16
(b) Payment Reference Id. : P531063558F7
# - These Fields CANNOT be edited by candidate, but written request can be made to the CONVENER or Regional Coordinator of AP ICET - 2023 or email to
helpdeskapicet2023@gmail.com Remaining fields can be edited by the candidate during the permitted period. For any details contact at 9000977657.
Declaration : 1) I have carefully gone through the instruction booklet and I am conversant with the instructions. I shall abide by the eligibility conditions
and other regulations to be satisfied for appearingat the entrance test and admission into any course prescribed. Further, I assure that, I will not
involve in any malpractise or illegal activities in the entrance test. In case, I have furnished any false information or involved in any
malpractise or illeagal activities, I am liable for punishment as per the existing law.
2) I am responsible for the corrections of the above details filling by me and the CONVENER AP ICET - 2023 is not responsible in
anyway.
Date : 23/05/2023 12:28 PM
SIGNATURE and LEFT HAND THUMB impression of the candidate to be done in the presence of the Invigilator on
Affix a recent color the day of Examination in the Examination Hall
photograph (3.5 cmX3.5 cm)
and get attested by a SIGNATURE OF THE CANDIDATE
Gazetted Officer or the in the presence of the Invigilator Left Thumb Impression
Principal of the College
where studied (Well in
advance BEFORE
EXAMINATION)
Note : 1) ALL the candidates have to submit this form in the Examination Hall to the Invigilator.
2) Candidates are not allowed into the Examination Hall even if they are LATE BY A MINUTE.
3) This is computer Generated sheet and does not require the signature of the CONVENER, AP ICET - 2023
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