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:
Its only a Edit Copy to check the details - Take the FINAL Copy after Payment.
49202118134957
Online Application Form

I.General Details

Candidate Name : SANTOSH SANJAY VALASANG

ತಂದ Father Name/Guardian Name SANJAY VALASANG

Mother Name SHOBHA VALASANG

ಂ Date of Birth 18-10-2004

ಂ Mobile Number & Email 98XXXXXX18 - v****1@g****l.com

Candidate Nationality INDIAN - Resident of India

ಂ Candidate Gender MALE

Candidate Address MALAKANADEVAR HATTI,TIKOTA,VIJAYAPURA,

TIKOTA, VIJAYAPURA (BIJAPUR), KARNATAKA -
586130
Applied Courses
PCM -(Physics Chemistry Mathematics for UG - CET Engineering)
PCB -(Physics Chemistry Biology for Nursing/Veternary/Yoga & Naturopathy/Agriculture/Pharmacy)
PCMB -(Physics Chemistry Mathematics Biology for ALL Courses)

Agriculture Exam Centers

College of Agri. University of Agri. Sciences, Krishi Nagar, Dharwad
Exam Centers
Exam Center (Priority 1) HUBBALLI (HUBLI)
Exam Center (Priority 2) DHARWAD

Eligibility and Caste Reservation Claimed / Income Details

Quota claimed / ತ Eligibility KARNATAKA - CLAUSE - B

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

ಂ ಂ 4
ತ
Total number of years of study in Karnataka (From
1st to 12th Std.)
Reservation category - 3B - ವ ಶ ಗ
Name of the Caste

ಮ ತ ಂ RD0039332069895
Caste Certificate RD Number
Printed Date: 07-02-2025 02-47-10 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:
Its only a Edit Copy to check the details - Take the FINAL Copy after Payment.
49202118134957
ದ ಮ ತ ಂ Income Certificate RD
Number
Annual Income 35000

Other Reservation claimed Details

EX-DEFENCE (ONLY FOR KARNATAKA) YES EX-SERVICEMEN
IDENTI
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) VIJAYAPURA (BIJAPUR)
ದ ಂ PUC Student Number & Year of 640564 - MAR2023-
Passing
ಂ NO - 202118134957

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
9 2020 29031400119-KENDRIYA VIDYALAYA VIJAYAPURA,K V VIJAYAPURA VIJAYAPUR
10 2021 29031400119-KENDRIYA VIDYALAYA VIJAYAPURA,K V VIJAYAPURA VIJAYAPUR
11 2022 TUNGAL SCIENCE PU COLLEGEITTANGIHAL YATNAL ROAD TQ TIKOTA DIST
BIJAPUR
Printed Date: 07-02-2025 02-47-10 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:
Its only a Edit Copy to check the details - Take the FINAL Copy after Payment.
49202118134957
12 2023 TUNGAL SCIENCE PU COLLEGEITTANGIHAL YATNAL ROAD TQ TIKOTA DIST
BIJAPUR

Payment Details
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: 07-02-2025 02-47-10 Page No: 3

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

CANDIDATE CLAIM DETAILS

REG NO. 49202118134957 NATIONALITY Indian
NAME SANTOSH SANJAY MOTHER TONGUE Kannada
VALASANG
GENDER MALE CATEGORY 3B
DATE OF BIRTH 18/10/2004 CASTE NAME ಶ ಂ ತ
CATEGORY 3B RELIGION Hindu
SUPERNUMERARY YES INCOME 35000
QUOTA
HYD-KARNATKA NO ELIGIBILITY CLAUSE Clause - b
JK-MIGRANT NO NRI WARD NO
SPECIAL CATEGORY

CLAIMED STUDY YEARS SUMMARY IN KARNATAKA

SL. CLAIMED VERIFIED REMARKS
NO
1 STUDY YEARS IN KARNATAKA 4 0 CLAIMED AND NOT VERIFIED
2 STUDY YEARS IN KANNADA MEDIUM 0 NOT CLAIMED
3 STUDY YEARS IN RURAL DISTRICTS 0 NOT CLAIMED
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.

Downloaded Date: 2/7/2025 2:47:10 PM

Printed Date: 07-02-2025 02-47-10 Page No: 4