2/29/2020

Application for PET-2020

REGISTRATION NO: BHU00611558470 PAYMENT ID: BHUP56115580335v

IDENTIFICATION TYPE : Pan Card IDENTIFICATION NO. EBHPB7158C

Course Code & Name: (470) M.Com.

पाठय म का नाम :
Candidate Name: SAMBIT KUMAR BISWAL
आवेदक का नाम :
Father's Name: HIMANSHU KUMAR BISWAL
िपता का नाम :
Mother's Name: LALITA BISWAL
माता का नाम:
Father's / Mother's Mobile 9437333036
Number:
िपता / माता का मोबाइल नंबर :
Date of Birth: 10. April .2000
ज ितिथ :

Sex/िलंग: MALE Category/वग: OBC

Blood Group: A+ Employee's Ward: NO

ड ुप : कमचारी पु पु ी :
Physically Challenged: NO Sports Seat: NO
शारी रक िवकलां गता: ोट् स सीट :
Nationality/रा ीयता : Indian Do you belong to "BHU Student NO
Category"?:
Religion/धम: HINDU ा आप बी.एच.यू िवदयाथ की ेणी म ह

Address For Correspondence प ाचार का पता Permanent Address थायी पता

Name: SAMBIT KUMAR BISWAL Guardian's Name (If
आवेदक का नाम Applicable)

AT- ANANTAPUR, KAMAKHYANAGAR N.A.C Address (पता ) : AT- ANANTAPUR, KAMAKHYANAGAR N.A.C
Address (पता ) :
KAMAKHYANAGAR, DIST- DHENKANAL KAMAKHYANAGAR, DIST- DHENKANAL
PIN-759018 PIN-759018

District (िजला): DHENKANAL District (िजला): DHENKANAL

Odisha State (रा ): Odisha

State (रा ):
759018 Pin (िपन) : 759018
Pin (िपन) :
Ph. No. with STD Code Ph. No. with STD Code
Fax No.
Mobile No. (मोबाइल नंबर ) 8342039668
Mobile No. (मोबाइल नंबर) 8342039668
Email sambitkumarbiswal054@gmail.com

Distance of your Residence from 500-999 Annual Income of your Less than 2,00,000
BHU . Parents/Guardians in Rs.

Test Center Preference परी ा के व रयता Opted Test Mode : COMPUTER BASED TEST (CBT)
Preference - 01 Cuttack [ Odisha ] Preference - 04 Balasore [ Odisha ]
Preference - 02 Bhubaneswar [ Odisha ] Preference - 05 Rourkela [ Odisha ]
Preference - 03 Dhenkanal [ Odisha ]

Signature Uploaded by
the candidate
अ थ ारा अपलोडे ड
ह ा र

It is hereby confirmed that I have carefully read the concerned Information Bulletin available on the BHU's Entrance Test Portal (www.bhuonline.in) before filling up the Application Form.
I hereby solemnly affirm that the information furnished in this Online Application Form is true and correct to the best of my lnowledge and belief and no material information has been concealed or
suppressed. If any information is found to be false, incorrect or misleading, the Banaras Hindu University shall have the authority to cancel my candidature / admission without any further enquiry
or notice.
I undertake that, if admitted, I shall abide by the UGC Regulations on Curbing the Menace of Ragging, 2009, Ordinances governing the discipline of students of banaras Hindu University and
such other Rules, Ordinances and Regulations that may be framed by the Banaras Hindu University/ UGC from time to time.
I further undertake that the preference for the Test center, Courses, Domicile and the categories to which I belong as indicated by me in the online application form shall be irrevocable.

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