GOVERNMENT COLLEGE(AUTONOMOUS), KALABURAGI

Application for Admission (2019)

Degree : BACHELOR OF SCIENCE
Semester : FIRST SEMESTER
Personal Details
Application No BSC210010528
Name LAXMI
Father Name SANGONDAPPA

Mother Name SHARADHA

Date of Birth Gender Category Caste

24/07/1997 Female IIA hindu ganiga

Handicap Nationality Annual Income Occupation

NONE INDIAN 36397 TEACHER

Address h no.3/5 UKP QTRS MALLAPUR BHEEMARAYANA GUDI

SHAHAPUR undefined ,undefined - 585287
Mobile Landline Email
9916633161 guruprasadsajjan@gmail.com

Bank Branch IFSC Code Bank A/C No

state bank of hydrabad
SBHY0020223 62298901195
Opted Course Details
Course BACHELOR OF SCIENCE FIRST SEMESTER
Sl. No. Subjcet Name Sub. Short Name
1 KANNADA KAN
2 PHYSICS PHY
3 MATHEMATICS MAT
4 STATISTICS STC
Basic Qualification Details
Qualification Combination Electives Register No
APPEARED PCM 15410832

Month / Year of Passing Institution / University

July/2019 VG WOMENS
Contact College Details
Code College Name
1001 Government College(Autonomous), Kalaburgi
Fee Details
Payment Mode Amount
Other Banks 1370
Reference No : BSC210010528
Payment Date UTR No Drawee Bank Bank Branch
2019-07-05 19:10:26 pay_Cq0F55bEo1aFMo

Date : 05/07/2019
Place : Signature of the Applicant

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 DECLARATION
I hereby solemnly and sincerely affirm that the statements made and information furnished in my application and also in the
enclosures submitted by me are true. Should it, however be found that the information furnished therein is not factually true, I
know that I am liable for prosecution and forfeiture of my admission. I have also taken note that once the admission process is
over, fee shall not be refunded by the university. In case of my grievances, I shall approach the university and in case of any
arbitration and any redressal of grievances I shall abide by the arbitration and territorial jurisdiction clause laid in the
prospectus.

Date : 05/07/2019
Place : Signature of the Applicant

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