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    Wa0016.

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    DOC-20241016-WA0016.

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    of 2

    Purnea University, Purnea (Bihar)

    Post-Graduate (PG) Admission Application Form


    SESSION 2024-2026

    UAN# 24P000006849 Appl. Date:08-10-2024 12:24 AM

    1. Candidate Name: KRISHNA MOHAN


    2. Father Name: PRAMODANAND MISHRA
    3. Mother Name: ANJANA DEVI
    4. Date of Birth: 24-06-2003 5. Gender: Male
    6. Category: GEN 7. Sub Category: Not Applicable
    8. Other Category: 9. AADHAAR: 367546830134
    10. Domicile: Bihar 11. Dom. Cert
    12. Religion Hindu 13. Minority No
    14. Nationality Indian 15. EWS Status No
    16. Acknowledgement No 17. Regstriation No. 2112B260035
    17.Quota Selection
    Quota Claimed: Quota Specialization:
    18.Address for Correspondence: 19.Permanent Address
    SAMRAT CHOWK, TATMA SAMRAT CHOWK, TATMA TOLI,
    TOLI, PURNEA PURNEA
    NEAR MAHAMAYA TEMPLE NEAR MAHAMAYA TEMPLE
    Purnia Purnia
    Bihar Bihar
    854301 854301

    20. Mobile 6207223014 21. Email [email protected]

    22. Payment Details Paid Rs 1000.00 on 06-09-2024 Ref#11000239285754


    23.Qualification
    Examination Board/University Year Roll No. Max Mark obt. Mark Percentage
    Bihar School Examination
    10th 06-2018 1800186 500 363 72.60
    Board(BSEB)
    Bihar School Examination
    12th 03-2021 21010100 500 371 74.20
    Board(BSEB)
    Graduation Purnea University, Purnea(PUP) 08-2024 211886 1500 1008 67.20
    Graduation Qualification
    Honours Name Honours Obtained Mark Honours MaxMark Percentage%
    Mathematics 595 800 74.38
    24.College/Course Chosen
    Prefernce# District College Degree Subject
    1 Purnea P.G Department MSC M.S.C IN Mathematics
    2 Purnea Purnea College, Purnia MSC M.S.C IN Mathematics
    3 Araria Araria College, Araria MSC M.S.C IN Mathematics
    4 Kishanganj Marwari College, Kishanganj MSC M.S.C IN Mathematics

    Declaration
    I declare that i have never been convicted for any criminal act and that there is no case pending against me in the court of law.I also declare that i
    have never been caught using Unfair Means or any Disciplinary action has been taken against me.if i was charged for using Unfair Means,the
    punitive duration is over and charges have been cleared.I have read carefully and have understood all rules as mentioned in the University Rules
    and Admission Brochure.Furthermore i also declare that if my application is found to contain incorrect/false information regarding my Name,Birth
    Date,Gender,Relligion,Domicile,Weightage,Caste,Horizontal Reservation,Marks obtained or any other field,my application is liable to get
    cancelled,and I will have no objection in getting disqualified for admission to the concerned course/college.

    Full Signature of the Aplicant


    Options checked during Application

    Document Checklist
    Note: Mark the number of documents (Photocopy/Xerox) attached by the candidate during form submission to the college.

    Xth Marksheet Xth Certificate


    XIIth Marksheet Last Exam Passed Marksheet
    Graduation Marksheet Graduation Certificate
    Recent Pssport Size Photograph Scanned Signature
    Domicile (for other state) Certificate for Kashmiri Resident
    Certificate for Category Certificate for Sub-Category
    Document for Claiming Weightage Other Certificate/Document

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