Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application -
2025 2025
2025-26 2
BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm Science courses
[B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental, Ayurveda, Unani,
Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2025-26
Appln No:
Final Copy
3920230400741
Online Application Form
I.General Details
Candidate Name : MOHAK M
ತಂದ Father Name/Guardian Name MAHESH K R
Mother Name ASHWINI K S
ಂ Date of Birth 02-12-2007
ಂ Mobile Number & Email 63XXXXXX70 - a****6@g****l.com
Candidate Nationality INDIAN - Resident of India
ಂ Candidate Gender MALE
Candidate Address P AND T COLONY, 2ND STAGE, NEAR KIRAN
CONVENT, LAKSHMIPURA EXTENSION,, HASSAN,
HASSAN, KARNATAKA - 573201
Applied Courses
PCM -(Physics Chemistry Mathematics for UG - CET Engineering)
Exam Centers
Exam Center (Priority 1) UJIRE
Exam Center (Priority 2) PUTTUR
Eligibility and Caste Reservation Claimed / Income Details
Quota claimed / ತ Eligibility KARNATAKA - CLAUSE - A
Clause Code
ಮ ತೃ ಭ ಷ ತ Mother Tongue & Religion KANNADA / HINDU
ಂ ಂ 12
ತ
Total number of years of study in Karnataka (From
1st to 12th Std.)
Reservation category - 2A - KURUBA
Name of the Caste
ಮ ತ ಂ RD0038473949899
Caste Certificate RD Number
ದ ಮ ತ ಂ Income Certificate RD
Number
Annual Income 30000
Printed Date: 11-02-2025 10-17-06 Page No: 1
Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application -
2025 2025
2025-26 2
BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm Science courses
[B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental, Ayurveda, Unani,
Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2025-26
Appln No:
Final Copy
3920230400741
Other Reservation claimed Details
RELIGIOUS MINORITY NO
LINQUISTIC MINORITY NO
STUDY IN KANNADA MEDIUM FROM 1 TO 10TH NO
STUDY IN RURAL AREAS FROM 1 TO 10TH YES -
JAMMU & KASHMIR MIGRANTS NO
KALYANA KARNATAKA (371 (J)) NO
NRI-WARD NO
Academic Details
Do you write/appearing Board Exam of 12th in Karanataka? Yes
ಂ KARNATAKA ( STATE BOARD )
State of 2nd PUC / 12th/ Equivalent exam & Qualifying Examination Board
College Type PRIVATE
ಂ KARNATAKA ( STATE BOARD )
State of 2nd PUC / 12th/ Equivalent exam & Qualifying Examination Board
District of 2nd PUC/12th/Equivalent exam (if studied in karnatka) MANGALURU (DAKSHINA
KANNADA)
ದ ಂ PUC Student Number & Year of 20259720128 - 2025-
Passing
ಂ YES - 20230400741
Completed SSLC from KSEEB, Govt. of Karnataka? and Registration
Number
ಂತ ಂ NO
Have you Appeared for NEET Exams before 2025? / CET Number / Year of
appearance
Study Details
ಂ
ತ Passed Name and Address of the School and Address
Passed Class Year
1 2014 VIJAYA SCHOOLCHIKKAHONNENAHALLI, NEAR RING ROAD, HASSAN
2 2015 VIJAYA SCHOOLCHIKKAHONNENAHALLI, NEAR RING ROAD, HASSAN
3 2016 VIJAYA SCHOOLCHIKKAHONNENAHALLI, NEAR RING ROAD, HASSAN
4 2017 VIJAYA SCHOOLCHIKKAHONNENAHALLI, NEAR RING ROAD, HASSAN
5 2018 VIJAYA SCHOOLCHIKKAHONNENAHALLI, NEAR RING ROAD, HASSAN
6 2019 VIJAYA SCHOOLCHIKKAHONNENAHALLI, NEAR RING ROAD, HASSAN
7 2020 VIJAYA SCHOOLCHIKKAHONNENAHALLI, NEAR RING ROAD, HASSAN
8 2021 VIJAYA SCHOOLCHIKKAHONNENAHALLI, NEAR RING ROAD, HASSAN
Printed Date: 11-02-2025 10-17-06 Page No: 2
Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application -
2025 2025
2025-26 2
BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm Science courses
[B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental, Ayurveda, Unani,
Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2025-26
Appln No:
Final Copy
3920230400741
9 2022 VIJAYA SCHOOLCHIKKAHONNENAHALLI, NEAR RING ROAD, HASSAN
10 2023 VIJAYA SCHOOLCHIKKAHONNENAHALLI, NEAR RING ROAD, HASSAN
11 2024 EXCEL PU COLLEGEGURUVAYANAKERE KUVETTU VILLAGE
12 2025 EXCEL PU COLLEGEGURUVAYANAKERE KUVETTU VILLAGE
Payment Details
AppNo 3920230400741 Bank Ref No. pay_Ps3y7bgxcBdwkD
Application Fee Rs. 600 Bank Name Bill desk
Paid Date 05/02/2025
1 ಂ ಂತ ಂ ಂ ದ ಂ ಂ
2 ಂ ತ ದ ಮ 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
ಂತ ಮ ತ ಂ
ತಂ ಂ ಂ ಂ ಮ
ಮ ತಂ ಂ ಂ ಂತ ದ ಮ
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.
Signature of the
Candidate
Printed Date: 11-02-2025 10-17-06 Page No: 3
Government of Karnataka
Karnataka Examinations Authority
ONLINE CLAIM SLIP - 2025
ONLINE CLAIM SLIP - 2025
CANDIDATE CLAIM DETAILS
REG NO. 3920230400741 NATIONALITY Indian
NAME MOHAK M MOTHER TONGUE Kannada
GENDER MALE CATEGORY 2A
DATE OF BIRTH 02/12/2007 CASTE NAME Kuruba
CATEGORY 2A RELIGION Hindu
SUPERNUMERARY YES INCOME 30000
QUOTA
HYD-KARNATKA NO ELIGIBILITY CLAUSE Clause - a
JK-MIGRANT NO NRI WARD NO
SPECIAL CATEGORY
CLAIMED STUDY YEARS SUMMARY IN KARNATAKA
SL. CLAIMED VERIFIED REMARKS
NO
1 STUDY YEARS IN KARNATAKA 12 10 SATS VERIFIED -10
2 STUDY YEARS IN KANNADA MEDIUM 0 NOT CLAIMED
3 STUDY YEARS IN RURAL DISTRICTS 10 CLAIMED AND NOT VERIFIED
4 STUDY YEARS FOR LINGUISTIC CLAIM 0 NOT CLAIMED
5 STUDY YEARS FOR RELIGIOUS CLAIM 0 NOT CLAIMED
NOTE: 1.Not Verified Details to be Verified at the 12TH/PU College Level.
2. Sats Verified Candidates who are not having Kannada medium,Rural,Linguistic,Religious Claims No
need to vistit College for Verification.
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