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    MG 2023 MSB 2247

    Uploaded by

    mrsubratakumadhii

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    MG 2023 MSB 2247

    Uploaded by

    mrsubratakumadhii
    9 views2 pages

    Original Title

    MG-2023-MSB-2247

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    9 views2 pages

    MG 2023 MSB 2247

    Uploaded by

    mrsubratakumadhii

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    APPLICATION FORM

    APPLICATION NO : MG-2023-MSB-2247

    Program Details
    Institute MITS SCHOOL OF BACHELOR OF SCIENCE BACHELOR OF SCIENCE
    Program Course
    Applying For BIOTECHNOLOGY (BIOTECHNOLOGY) (BIOTECHNOLOGY)

    Personal Details
    Title MR.
    Name SUBRAT MADHI
    Email Address MRSUBRATAKUMADHII@GMAIL.COM
    Mobile Number +91-9178017537
    Martial Status SINGLE
    Blood Group B+
    Date Of Birth 19/08/2003
    Age as on 31st Dec 2022 19 YEARS , 4 MONTHS , 12 DAYS
    Gender MALE
    Nationality INDIAN
    Category ST
    Domicile State ODISHA
    Mother Tongue ODIA
    Aadhaar Card Number 701094035932
    Passport Number
    Passport Country
    Place Of Issue
    Date Of Issue
    Date Of Expiry
    Whether Physically Handicapped NO
    Hostel Accommodation required? YES
    Transport Facility required? YES
    From Where did you get to know about us? BGU WEBSITE
    Please specify

    Parent Details
    Father Mother
    Salutation MR. MRS.
    Name GANGA MADHI MUKE MADKAMI
    Mobile Number +91-9938414799 +91-9178017537
    Email Address GANGAMADHI8@GMAIL.COM MRSUBRATAKUMADHII@GMAIL.COM
    Occupation OTHER|FARMER HOMEMAKER
    Designation FARMER

    Address Details
    Is permanent address same as address for communication? YES
    Correspondence Permanent
    Address Line 1 AT-PANIMETLA BLOCK-KALIMELA DIST-MALKANGIRI AT-PANIMETLA BLOCK-KALIMELA DIST-MALKANGIRI
    Address Line 2 AT-PANIMETLA BLOCK-KALIMELA DIST-KALIMELA AT-PANIMETLA BLOCK-KALIMELA DIST-KALIMELA
    City Name MALKANGIRI MALKANGIRI
    District Name MALKANGIRI MALKANGIRI
    State Name ODISHA ODISHA
    Country Name INDIA INDIA
    Pincode 764047 764047

    Academic Details
    After 10th Qualification 12TH
    10th Details 12th Details Diploma Details
    JAWAHAR NAVODAYA VIDYALAYA-1 , JAWAHAR NAVODAYA VIDYALAYA-1,
    Institute Name
    MALKANGIRI MALKANGIRI
    CENTRAL BOARD OF SECONDARY CENTRAL BOARD OF SECONDARY
    Board / Univesity
    EDUCATION (CBSE) EDUCATION (CBSE)
    Mode of Class REGULAR REGULAR -
    Stream/Subjects - SCIENCE
    Year of Passing 2020 2022
    Result Status - DECLARED
    Marking Scheme PERCENTAGE PERCENTAGE
    Percentage/CGPA 65 67

    Graduation Details
    Graduation State Graduation University Graduation Institute

    Graduation Details
    Degree Specialization Year of Passing Result Status Marking Scheme Percentage/CGPA

    Upload Details

    Upload Your Signature

    Upload Your 10th Marksheet YES


    Upload Your 12th Marksheet YES
    Upload Your Diploma Marksheet NO
    Upload Your Graduation Marksheet NO

    Declaration
    I Hereby Declare That All Information Stated Above Are True To My Knowledge And Belief. I Satisfy All The Eligibility Criteria And Submit All
    Relevant Certificates Failing Which MITS Group Of Institutions Has Every Right To Cancel My Candidature.

    Applicant Name SUBRAT MADHI


    Parent Name GANGA MADHI
    Date 26/06/2023

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