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
3920230716104
Online Application Form
I.General Details
Candidate Name : JAVID MUJAWAR
ತಂದ Father Name/Guardian Name MALIKSAB
Mother Name BHISMILLA
ಂ Date of Birth 17-09-2006
ಂ Mobile Number & Email 82XXXXXX50 - m****6@g****l.com
Candidate Nationality INDIAN - Resident of India
ಂ Candidate Gender MALE
Candidate Address TELSANG, ATHANI, BELAGAVI (BELGAUM),
KARNATAKA - 591265
Applied Courses
PCMB -(Physics Chemistry Mathematics Biology for ALL Courses)
Agriculture Exam Centers
College of Agriculture, HittanaHalli Farm, Vijayapura
Exam Centers
Exam Center (Priority 1) ATHANI
Exam Center (Priority 2) JAMAKHANDI
Eligibility and Caste Reservation Claimed / Income Details
Quota claimed / ತ Eligibility KARNATAKA - CLAUSE - A
Clause Code
ಮ ತೃ ಭ ಷ ತ Mother Tongue & Religion URDU / MUSLIM
ಂ ಂ 12
ತ
Total number of years of study in Karnataka (From
1st to 12th Std.)
Reservation category - 2B -
Name of the Caste
ಮ ತ ಂ RD0038046471281
Caste Certificate RD Number
ದ ಮ ತ ಂ Income Certificate RD
Number
Printed Date: 13-02-2025 11-14-12 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
3920230716104
Annual Income 35000
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 YES -
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) BELAGAVI (BELGAUM)
ದ ಂ PUC Student Number & Year of 20259269377 - 2025-
Passing
ಂ YES - 20230716104
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 SHRI BASAVALING SWAMIJI KHPS TELASANGSBSKHPS TELSANG
2 2015 SHRI BASAVALING SWAMIJI KHPS TELASANGSBSKHPS TELSANG
3 2016 SHRI BASAVALING SWAMIJI KHPS TELASANGSBSKHPS TELSANG
4 2017 SHRI BASAVALING SWAMIJI KHPS TELASANGSBSKHPS TELSANG
5 2018 SHRI BASAVALING SWAMIJI KHPS TELASANGSBSKHPS TELSANG
6 2019 MORARJI DESAI RESIDENTIAL SCHOOL BC MADABHAVIMADABHAVI
SIDDEWADI ROAD
Printed Date: 13-02-2025 11-14-12 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
3920230716104
7 2020 MORARJI DESAI RESIDENTIAL SCHOOL BC MADABHAVIMADABHAVI
SIDDEWADI ROAD
8 2021 MORARJI DESAI RESIDENTIAL SCHOOL BC MADABHAVIMADABHAVI
SIDDEWADI ROAD
9 2022 MORARJI DESAI RESIDENTIAL SCHOOL BC MADABHAVIMADABHAVI
SIDDEWADI ROAD
10 2023 MORARJI DESAI RESIDENTIAL SCHOOL BC MADABHAVIMADABHAVI
SIDDEWADI ROAD
11 2024 SAINIKETAN PU COLLEGEATHANI CHIKODI DISTRICT
12 2025 SAINIKETAN PU COLLEGEATHANI CHIKODI DISTRICT
Payment Details
AppNo 3920230716104 Bank Ref No. pay_PvCJsNDZjYt5cE
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: 13-02-2025 11-14-12 Page No: 3
Government of Karnataka
Karnataka Examinations Authority
ONLINE CLAIM SLIP - 2025
ONLINE CLAIM SLIP - 2025
CANDIDATE CLAIM DETAILS
REG NO. 3920230716104 NATIONALITY Indian
NAME JAVID MUJAWAR MOTHER TONGUE Urdu
GENDER MALE CATEGORY 2B
DATE OF BIRTH 17/09/2006 CASTE NAME ಂ
CATEGORY 2B RELIGION Muslim
SUPERNUMERARY YES INCOME 35000
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 10 SATS VERIFIED -10
2 STUDY YEARS IN KANNADA MEDIUM 0 NOT CLAIMED
3 STUDY YEARS IN RURAL DISTRICTS 10 CLAIMED AND NOT VERIFIED
4 STUDY YEARS FOR LINGUISTIC CLAIM 0 NOT CLAIMED
5 STUDY YEARS FOR RELIGIOUS CLAIM 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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