Government of Karnataka

Karnataka Examinations Authority

Common UG Online Application -
2025 2025

2025-26 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm Science courses
[B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental, Ayurveda, Unani,
Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2025-26

Appln No:
Final Copy
4918172515
Online Application Form

I.General Details

Candidate Name : POORVITH GOWDA H M

ತಂದ Father Name/Guardian Name MANJEGOWDA H R

Mother Name CHETHANA A S

ಂ Date of Birth 27-05-2007

ಂ Mobile Number & Email 88XXXXXX13 - m****2@g****l.com

Candidate Nationality INDIAN - Resident of India

ಂ Candidate Gender MALE

Candidate Address HULIGERE GRAMA, CHANNARAYAPATTANA, HASSAN,

KARNATAKA - 573116
Applied Courses
PCM -(Physics Chemistry Mathematics for UG - CET Engineering)
PCB -(Physics Chemistry Biology for Nursing/Veternary/Yoga & Naturopathy/Pharmacy)
PCMB -(Physics Chemistry Mathematics Biology for ALL Courses)

Agriculture Exam Centers

College of Agriculture, Karekere, Hassan
Exam Centers
Exam Center (Priority 1) HASSAN
Exam Center (Priority 2) MYSURU (MYSORE)

Eligibility and Caste Reservation Claimed / Income Details

Quota claimed / ತ Eligibility KARNATAKA - CLAUSE - A

Clause Code
ಮ ತೃ ಭ ಷ ತ Mother Tongue & Religion KANNADA / HINDU

ಂ ಂ 12
ತ
Total number of years of study in Karnataka (From
1st to 12th Std.)
Reservation category - 3A -
Name of the Caste

ಮ ತ ಂ RD1218305008857
Caste Certificate RD Number

Printed Date: 19-02-2025 10-53-21 Page No: 1

 Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application -
2025 2025

2025-26 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm Science courses
[B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental, Ayurveda, Unani,
Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2025-26

Appln No:
Final Copy
4918172515
ದ ಮ ತ ಂ Income Certificate RD
Number
Annual Income 40000

Other Reservation claimed Details

RELIGIOUS MINORITY NO
LINQUISTIC MINORITY NO
STUDY IN KANNADA MEDIUM FROM 1 TO 10TH NO
STUDY IN RURAL AREAS FROM 1 TO 10TH NO
JAMMU & KASHMIR MIGRANTS NO
KALYANA KARNATAKA (371 (J)) NO
NRI-WARD NO

Academic Details
Do you write/appearing Board Exam of 12th in Karanataka? Yes
ಂ KARNATAKA ( STATE BOARD )
State of 2nd PUC / 12th/ Equivalent exam & Qualifying Examination Board
College Type PRIVATE
ಂ KARNATAKA ( STATE BOARD )
State of 2nd PUC / 12th/ Equivalent exam & Qualifying Examination Board
District of 2nd PUC/12th/Equivalent exam (if studied in karnatka) MANGALURU (DAKSHINA
KANNADA)
ದ ಂ PUC Student Number & Year of 20259720244 - 2025-
Passing
ಂ NO - 18172515

Completed SSLC from KSEEB, Govt. of Karnataka? and Registration

Number
ಂತ ಂ NO

Have you Appeared for NEET Exams before 2025? / CET Number / Year of
appearance

Study Details
ಂ

ತ Passed Name and Address of the School and Address

Passed Class Year
1 2014 Jnanasagara International Public School
2 2015 Jnanasagara International Public School Channarayapatna
3 2016 Jnanasagara International Public School Channarayapatna
4 2017 Jnanasagara International Public School Channarayapatna
5 2018 Jnanasagara International Public School Channarayapatna
Printed Date: 19-02-2025 10-53-21 Page No: 2
 Government of Karnataka
Karnataka Examinations Authority
Common UG Online Application -
2025 2025

2025-26 2

BPO
Common Online Common Application for Engineering, Naturopathy & Yoga, Veterinary, B. Pharma, 2nd year B.Pharma and Pharma-D, Farm Science courses
[B.Sc. (Hons) Agriculture, B.Sc. (Hons) Sericulture etc.,], and B.Sc. (Nursing) courses [including Architecture, Medical, Dental, Ayurveda, Unani,
Homoeopathy, B.P.T., B.Sc. Allied Health Sciences, BPO courses] for the Year 2025-26

Appln No:
Final Copy
4918172515
6 2019 Jnanasagara International Public School
7 2020 Sri Bhuvanendra Residential School Madava Nagara
8 2021 Sri Bhuvanendra Residential School Madava Nagara
9 2022 Sri Bhuvanendra Residential School Madava Nagara
10 2023 Sri Bhuvanendra Residential School Madava Nagara
11 2024 Excel PU College Guruvayankere, Mangalore,
12 2025 Excel PU College Guruvayankere, Mangalore,

Payment Details
AppNo 4918172515 Bank Ref No. pay_Pv7pBOpWBHPTaL
Application Fee Rs. 600 Bank Name Bill desk
Paid Date 13/02/2025
1 ಂ ಂತ ಂ ಂ ದ ಂ ಂ

2 ಂ ತ ದ ಮ ತ ತ
ದ ಂದ ಂ ಂತ ದ
NOTE : 1. After completion of all the process the candidates are required to take final print out of the Online Application
Form and submit the same during Document Verification.
2. The CASTE and INCOME certificate to be produced by candidates during seat selection process should have the
same CASTE and INCOME, as mentioned in this Application Form. No change in Caste / Category will be
permitted after the final declaration.

Declaration

ಂತ ಮ ತ ಂ
ತಂ ಂ ಂ ಂ ಮ
ಮ ತಂ ಂ ಂ ಂತ ದ ಮ
ತ ತ ಂ ಂ ಂ ಂ ಂ ದ

We declare that the information furnished through online is true and correct to the best of our knowledge and
belief. We have read the instructions carefully hosted on the KEA website "Information Bulletin for Filling up of
Online Application". In case any of the information furnished online by us is found to be false or incorrect, We are
also liable for action, that the State Government or the KEA may take against us in this regard.

Signature of the
Candidate

Printed Date: 19-02-2025 10-53-21 Page No: 3

 Government of Karnataka
Karnataka Examinations Authority
ONLINE CLAIM SLIP - 2025
ONLINE CLAIM SLIP - 2025

CANDIDATE CLAIM DETAILS

REG NO. 4918172515 NATIONALITY Indian
NAME POORVITH GOWDA H M MOTHER TONGUE Kannada
GENDER MALE CATEGORY 3A
DATE OF BIRTH 27/05/2007 CASTE NAME

CATEGORY 3A RELIGION Hindu

SUPERNUMERARY YES INCOME 40000
QUOTA
HYD-KARNATKA NO ELIGIBILITY CLAUSE Clause - a
JK-MIGRANT NO NRI WARD NO
SPECIAL CATEGORY

CLAIMED STUDY YEARS SUMMARY IN KARNATAKA

SL. CLAIMED VERIFIED REMARKS
NO
1 STUDY YEARS IN KARNATAKA 12 12 VERIFIED BY COLLEGE -12
2 STUDY YEARS IN KANNADA MEDIUM 0 0 NOT CLAIMED
3 STUDY YEARS IN RURAL DISTRICTS 0 0 NOT CLAIMED
4 STUDY YEARS FOR LINGUISTIC CLAIM 0 0 NOT CLAIMED
5 STUDY YEARS FOR RELIGIOUS CLAIM 0 0 NOT CLAIMED

NOTE: 1.Not Verified Details to be Verified at the 12TH/PU College Level.

2. Sats Verified Candidates who are not having Kannada medium,Rural,Linguistic,Religious Claims No
need to vistit College for Verification.

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