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
3920230541006
Online Application Form
I.General Details
Candidate Name : MADAN K K
ತಂದ Father Name/Guardian Name KUMAR K R
Mother Name NANDINI
ಂ Date of Birth 14-08-2007
ಂ Mobile Number & Email 99XXXXXX92 - m****7@g****l.com
Candidate Nationality INDIAN - Resident of India
ಂ Candidate Gender MALE
Candidate Address KUMBARGATTE,SAKLESHPUR TALUK, YADEHALLI,
PO:BAGE, DIST:HASAN,KARNATAKA,573214,
SAKLESHPUR, HASSAN, KARNATAKA - 573214
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 - GM - VEERASHAIVA LINGAYAT
Name of the Caste
ಮ ತ ಂ RD1218979007143
Caste Certificate RD Number
ದ ಮ ತ ಂ Income Certificate RD
Number
Annual Income 70000
Printed Date: 18-02-2025 10-57-01 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
3920230541006
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 20259720080 - 2025-
Passing
ಂ YES - 20230541006
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 29230808005-VIVEKA ENGLISH HPS, BANAVASE, BALLU,NULL
2 2015 29230808005-VIVEKA ENGLISH HPS, BANAVASE, BALLU,NULL
3 2016 VIVEKA CONVENT BANAVASEVIVEKA CONVENT BANAVASE BALLUPET
SAKALESHPUR HASSAN
4 2017 VIVEKA CONVENT BANAVASEVIVEKA CONVENT BANAVASE BALLUPET
SAKALESHPUR HASSAN
5 2018 VIVEKA CONVENT BANAVASEVIVEKA CONVENT BANAVASE BALLUPET
SAKALESHPUR HASSAN
Printed Date: 18-02-2025 10-57-01 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
3920230541006
6 2019 VIVEKA CONVENT BANAVASEVIVEKA CONVENT BANAVASE BALLUPET
SAKALESHPUR HASSAN
7 2020 VIVEKA CONVENT BANAVASEVIVEKA CONVENT BANAVASE BALLUPET
SAKALESHPUR HASSAN
8 2021 VIVEKA HIGH SCHOOL BALLUPETEBANAVASE SAKALESHPURA TQ HASSAN
DIST BALLUPETE
9 2022 VIVEKA HIGH SCHOOL BALLUPETEBANAVASE SAKALESHPURA TQ HASSAN
DIST BALLUPETE
10 2023 VIVEKA HIGH SCHOOL BALLUPETEBANAVASE SAKALESHPURA TQ HASSAN
DIST BALLUPETE
11 2024 EXCEL PU COLLEGEGURUVAYANAKERE KUVETTU VILLAGE
12 2025 EXCEL PU COLLEGEGURUVAYANAKERE KUVETTU VILLAGE
Payment Details
AppNo 3920230541006 Bank Ref No. pay_PqKYGu86wnqC51
Application Fee Rs. 600 Bank Name Bill desk
Paid Date 01/02/2025
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: 18-02-2025 10-57-01 Page No: 3
Government of Karnataka
Karnataka Examinations Authority
ONLINE CLAIM SLIP - 2025
ONLINE CLAIM SLIP - 2025
CANDIDATE CLAIM DETAILS
REG NO. 3920230541006 NATIONALITY Indian
NAME MADAN K K MOTHER TONGUE Kannada
GENDER MALE CATEGORY GM
DATE OF BIRTH 14/08/2007 CASTE NAME Veerashaiva Lingayat
CATEGORY GM RELIGION Hindu
SUPERNUMERARY YES INCOME 70000
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 12 VERIFIED BY COLLEGE -12
2 STUDY YEARS IN KANNADA MEDIUM 0 0 NOT CLAIMED
3 STUDY YEARS IN RURAL DISTRICTS 10 10 CLAIMED AND VERIFIED
4 STUDY YEARS FOR LINGUISTIC CLAIM 0 0 NOT CLAIMED
5 STUDY YEARS FOR RELIGIOUS CLAIM 0 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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