GOVERNMENT OF BIHAR

Bihar Combined Entrance Competitive Examination Board

Online Application Form for Bihar Combined entrance Competitive Examination (BCECE) -2018
for admission to First Year Degree Courses
Registration No. 2180013500 Please donot send this Hard Copy to BCECE Board
PART- A
1. Course Group Applied For : PCM

2. Name of Candidate : SHUBHAM DEEP

3. Father's Name : SANJAY KUMAR

4. Date of Birth: : 27/ February /2001

5. Gender : Male

6: Reservation Category : BC (Backward Caste)

7. Disabled Quota : No

8. Mobile No. : 9097424287

9. Aadhaar Card No : 485377300343 Note: Please Affix your same photo and put your full
signature in English and Hindi in spaces provided above.

10. Email ID : [email protected]

11. Marks of identification : cut mark on nose

12. Are You Permanent Resident of Bihar? : Yes
13. Residential Eligibility
:
14. Are you unable to write due to permanent loss of limbs / suffering from : N/A
Cerebral palsy :
15. District Name of the Institute of passing/appearing at I.Sc or equivalent : PATNA
16. Do you claim for Agriculture Stream Courses : No
17. Father's Annual Income : More than 4.5 lakhs
18. Do you claim SMQ Quota : No
19. Are you Son/Unmarried Daughter of Military Personnel? : N/A
20. Have you passed matriculation with URDU as a subject? : N/A
21. Percentage of marks obtained in qualifying examination, if Passed:
(Physics+Chemistry+Maths): N/A (English): N/A
22. Payment Details:

Payment Mode Journal No. / Transaction No. Deposit Date Amount (in Rs.)
ONLINE BCE5aad2f422fa06 2018-03-17 20:40:24 Rs. One Thousand
23. Address Details:
A. Permanent Address: B. Correspondence Address:
Sai Gharounda,Roti Restaurant,End of Grill Gali, Sai Gharounda,Roti Restaurant,End of Grill Gali,
Patliputra Patliputra
District: PATNA District: PATNA
State: Bihar Pin Code: 800013 State: Bihar Pin Code: 800013
Declaration by the Candidate: I SHUBHAM DEEP declare that information furnished above are correct and I shall forfeit my candidature
and will be liable for legal action in case of any of them is proved to be false at any stage inclusive of admission or thereafter.

Date: .................
Place: ................... (Signature in English) (Signature in Hindi)

Registration No: 2180013500 Page: 1/1

 GOVERNMENT OF BIHAR
Bihar Combined Entrance Competitive Examination Board
Online Application Form for Bihar Combined entrance Competitive Examination (BCECE) -2018
for admission to First Year Degree Courses
Registration No. 2180013500 Please donot send this Hard Copy to BCECE Board
PART- B
(For office use only)
Select for admission(First Counseling) Select for admission(Second Counseling) Select for admission(Third Counselling)

Against Roll No............................................... Against Roll No............................................... Against Roll No...............................................

Reservation Category.................................... Reservation Category.................................... Reservation Category....................................

Merit Serial .................................................. Merit Serial ................................................. Merit Serial ..................................................

at....................................................(institution) at....................................................(institution) at....................................................(institution)

in...................................... (Courses/Branch) in...................................... (Courses/Branch) in...................................... (Courses/Branch)

Signature of Signature of Controller of Signature of Signature of Controller of Signature of Signature of Controller of

the Candidate the verifying Examination the Candidate the verifying Examination the Candidate the verifying Examination
(At the time of Officer BCECEB (At the time of Officer BCECEB (At the time of Officer BCECEB
Counseling) BCECE-2018 Counseling) BCECE-2018 Counseling) BCECE-2018
Date: Date: Date:

1. Course Group Applied For : PCM

2. Name of Candidate : SHUBHAM DEEP

3. Father's Name : SANJAY KUMAR

4. Date of Birth: : 27/ February /2001

5. Gender : Male

6. Reservation Category : BC (Backward Caste)

7. Disable Quota : No

8. Mobile No. : 9097424287

9. Aadhaar Card No : 485377300343

Note: Please Affix your same photo and put your full signature
10. Email ID : [email protected] in English and Hindi in spaces provided above.

11. Marks of identification : cut mark on nose

12. Are You Permanent Resident of : Yes

Bihar?
13. Residential Eligibility
:
14. Are you unable to write due to permanent loss of limbs / suffering from : N/A
Cerebral palsy :
15. District Name of the Institute of passing/appearing at I.Sc or equivalent : PATNA
16. Do you claim for Agriculture Stream Courses : No
17. Father's Annual Income : More than 4.5 lakhs
18. Do you claim SMQ Quota : No
19. Are you Son/Unmarried Daughter of Military Personnel? : N/A
20. Have you passed matriculation with URDU as a subject? : N/A
21. Percentage of marks obtained in qualifying examination, if Passed:
(Physics+Chemistry+Maths): N/A (English): N/A

Registration No: 2180013500 Page: 1/3

 22. Address Details:
A. Permanent Address: B. Correspondence Address:
Sai Gharounda,Roti Restaurant,End of Grill Gali, Sai Gharounda,Roti Restaurant,End of Grill Gali,
Patliputra Patliputra
District: PATNA District: PATNA
State: Bihar Pin Code: 800013 State: Bihar Pin Code: 800013
23. Educational Qualification:

Level School/College Name Board/ University Name Passing Status Passing Year
Secondary/Standard Central Board of Secondary
DAV Public School, BSEB Colony Passed 2016
X Education
Central Board of Secondary
I.S.C./XII (10+2) DAV Public School,BSEB Colony Appearing 2018
Education
(Submit Marksheet of Matriculation and I.Sc. if passed)

24. Marks Details:

% of Marks
Subject in I.Sc/10+2 % of Marks % of Marks % of Marks
S.N. Marks Obtained Total Marks obtained in
Exam obtained in PCM obtained in PCB obtained in CBA
English
1 English N/A N/A
2 Physics N/A N/A
N/A N/A N/A N/A
3 Chemistry N/A N/A
4 Maths N/A N/A

25. Declaration of the Candidate:

I, SHUBHAM DEEP Son/ Daughter of SANJAY KUMAR hereby solemnly and sincerely affirm the statements made and information furnished
above by me and in the enclosures hereby submitted by me are true and correct. I have not kept my information secret. If, however, it is found
that any information furnished therein is fraudulent, incorrect or untrue in materials/particulars, I realize that I am liable criminal prosecution and
agree to forego my seat in the college and further that the selection and admission to this course is liable to be canceled. I agree to abide by the
rules and regulations governing this Examination and as contained in the prospectus of BCECE-2018.

Repeat below in your handwriting (not in capital letters) the above mentioned Declaration and put your signature in English and Hindi
at the specified spaces as signed in Part A of the Online Application Form. If you fail to do so, your Candidature shall be rejected:

...............................................................................................................................................................................................................................

...............................................................................................................................................................................................................................

...............................................................................................................................................................................................................................

...............................................................................................................................................................................................................................

...............................................................................................................................................................................................................................

...............................................................................................................................................................................................................................

Place: Full Signature (in Hindi) ..................................

Date: Full Signature (in English) ..................................

Counter Signature of Father/Mother/Husband/Guardian ..................................

26. List of Enclosure:

1.
2.
3.
4.
5.
6.
7.
8.

Registration No: 2180013500 Page: 2/3

 27.
(AT THE TIME OF FIRST COUNSELLING/INTERVIEW ONLY)
(I) Full signature of the candidate (ii) L.T.I of the Candidate
(English)

(Hindi)

(AT THE TIME OF SECOND COUNSELLING/INTERVIEW ONLY)

(I) Full signature of the candidate (ii) L.T.I of the Candidate
(English)

(Hindi)

(AT THE TIME OF THIRD COUNSELLING/INTERVIEW ONLY)

(I) Full signature of the candidate (ii) L.T.I of the Candidate
(English)

(Hindi)

28.
(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF FIRST COUNSELLING)

Roll No. ........................................ Reservation Category .................................... Merit Serial ............... of BCECE-2018 in the

First Year of ........... Branch/Course of the Institute ................................................ as He/She fulfilled all the requirements of being

admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE

DIRECTOR/PRINCIPAL

(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF SECOND COUNSELLING)

Roll No. ........................................ Reservation Category .................................. Merit Serial ............... of BCECE-2018 in the First

Year of .......... Branch/Course of the Institute ................................................ as He/She fulfilled all the requirements of being

admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE

PRINCIPAL/SUPERINTENDENT

(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF THIRD COUNSELLING)

Roll No........................................ Reservation Category .................................. Merit Serial ............... of BCECE-2018 in the First

Year of ............ Branch/Course of the Institute ................................................ as He/She fulfilled all the requirements of being

admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE

PRINCIPAL/SUPERINTENDENT

Registration No: 2180013500 Page: 3/3