Filled in Online Application Form

1. (a) Candidate's Name # : THIPPARAPU AKSHITHA

Preserve the Registration Number for
(b) Father's Name # : NARSINGA RAO
all future correspondence.
(c) Mother's Name # : VANI
REGISTRATION NO. :
(d) Date of Birth (as per SSC or Equivalent) # : 08/08/1999
(e) Birth State, Birth District : TELANGANA - JAYASHANKAR BHUPALAPALLY
5210546201
(f) Gender : FEMALE
(g) Identification Marks 1 : A MOLE BELOW THE LEFT EYE
(h) Identification Marks 2 : N.A
2. (a) Category : BC_D
2. (b) Do you belong to EWS? : N.A
2. (c) EWS Certificate Number : N.A
3. (a) Special Reservation Category : N.A
(b) Physically Challenged(PH) : N.A
4. Local Area : OU
5. (a) Non-Minority / Minority : NON-MINORITY
(b) Minority Category : N.A
6. Annual Income of the Parents (Rs.) : Below One Lakh
7 (a) Qualifying Examination# : BSc
(b)University and College of Qualifying Examination : KAKATIYA UNIVERSITY/KANISHKA
(c) Qualifying Exam Hall Ticket No # : 512184254
(d) Year of App./Passing the Qualifying Exam : 2020
(e) Medium of Instruction at Qualifying Exam : English
(f) Percentage of Qualifying Exam : 76.00
(g) Place of Study - Intermediate or Equivalent : URBAN
8. (a) Study Details
Class-6 WARANGAL RURAL Class-7 WARANGAL RURAL
Class-8 WARANGAL RURAL Class-9 WARANGAL RURAL
Class-10 WARANGAL RURAL Inter 1st year / Equivalent WARANGAL URBAN
Inter 2nd year / Equivalent WARANGAL URBAN Degree WARANGAL URBAN
(b) Place of Study - SSC or Equivalent : RURAL
(c) SSC Hall Ticket Number & Year of Passing # : 1532124843 , May - 2015
(d) SSC Board # : TS SSC
(e) Inter Hall Ticket Number & Year of Passing # : 1738231781 , April - 2017
9. Medium of Test : English&Telugu
10. (a) Address for Correspondence : 5-92, MOGULLAPALLI,
MOGULLAPALLI, JAYASHANKAR BHUPALPALLY,
TELANGANA, 506366
(b) Contact Telephone Number (Mobile) : 9849335523 (c) E-Mail Id : [email protected]
(d) Aadhaar Card number : 757549009799
11.Regional Test Centre Preferences
Preference - 1 Preference - 2 Preference - 3
Hyderabad Khammam Vijayawada
12. (a) Fee particulars - Payment through : ONLINE (c) Amount (in Rs.) : 1150.00
(b) Payment Reference Id. :
TSP52109437818
13.Help Line Centre :
WARANGAL
# - These Fields CANNOT be edited by candidate, but written request can be made to the CONVENER or Regional Coordinator of TS ICET 2020 or email to [email protected]
Remaining fields can be edited by the candidate during the permitted period. For any details contact at 0870-2438088.

Declaration : 1) I have carefully gone through the instruction booklet and I am conversant with the instructions. I shall abide by the eligibility conditions and other regulations to be
satisfied for appearing at the entrance test and admission into any course prescribed. Further, I assure that, I will not involve in any malpractice or illegal activities in the
entrance test. In case, I have furnished any false information or involved in any malpractice or illegal activities, I am liable for punishment as per the existing law.
2) I am responsible for the corrections of the above details filling by me and the CONVENER TS ICET-2020 is not responsible in anyway.

Date : 20/06/2020 06:31 AM

SIGNATURE and LEFT HAND THUMB Impression of the candidate to be done in the presence of the Invigilator on the day
of Examination in the Examination Hall
SIGNATURE OF THE CANDIDATE in the Left Hand Thumb Impression
presence of the Invigilator
Affix a recent color photograph
(3.5 cm X 3.5 cm) and get attested by a Gazetted
Officer or the Principal of the College where
studied
(Well in advance BEFORE EXAMINATION)

Note : 1) ALL the candidates have to submit this form in the Examination Hall to the Invigilator.
2) Candidates are not allowed into the Examination Hall even if they are LATE BY A MINUTE.
3) This is computer Generated sheet and does not require the signature of the CONVENER, TS ICET-2020