Entrance Date : - 9th May 2015 (Saturday)

SAAT : 2015

Application No.:716618

Program Detail
Your present Qualification:

B.Sc

Course Applied for :

(42) M.Sc. Biotechnology

Test Centre :

1-(18)Bhubaneswar, 2-(20)Cuttack, 3-(25)Puri

Personal Detail
Candidate Name :

SOMYA PRUSTY

Relationship :

Father

Father Name :

BIJAN KUMAR PRUSTY

Date Of Birth :

18/05/1994

Mobile No:

9439896612

STD Code :

751014

Phone No :

Identity Proof :

Driving License

Identity Proof No :

OR1720120062157

Mother Toungue :

Odia

Nationality :

Indian

Gender :

Male

Email Id :

somyaprusty595@gmail.com

Category :

Gen

Resident State:

Odisha

Alternative Mobile No : 8908401224

Correspondence Address
C/o Name :

BIJAN KUMAR PRUSTY

Locality :

House-No/Village : CH-258,MANA BANDH PADA,HATPADA

City :

BARGARH

District :

BARGARH

State :

ODISHA

Country :

INDIA

Pin Code :

768028

Mobile No :

9439896612

Qualifying Detail
10th Exam Percentage :

83

12th Exam Percentage :

68

Graduation Marks:
Year Of Qualifying :

2015

Qualifying Exam :

Appeared/Appearing

Roll No./Reg.No. :

1202010290040191

SAAT : 2015

Application No.:716618

SAAT-2015

C/o: BIJAN KUMAR PRUSTY

CH-258,MANA BANDH PADA,HATPADA
BARGARH BARGARH
Odisha

INDIA

PIN CODE :768028

MOBILE NO. : 9439896612

Driving License:OR-1720120062157

somyaprusty595@gmail.com

Online Payment Details

Order Id: 716618
Date : 22/02/2015

Transaction No : 2000005974
Amount : 500/-

Receipt No. : 505316656783

DECLARATION BY THE CANDIDATE

I here declare that all the particulars stated in this application are true to the best of my knowledge and belief. I have read the
Information Brochure and I shall abide by the terms and conditions.In the event of suppression or distortion of any fact like
suppressing like category or education qualification or nationality etc. made in my application form, I understand that I will be denied
the opportunity to appear in SAAT-2015 and if already admitted, my admission /degree /degree acquired is liable for cancellation. I
understand that the decision of the Siksha 'O' Anusandhan University Regarding my admission to engineering / Medical /Dental
/Nursing /Pharmacy /Biotechnology /MBA /Hotel Management /MCA /Law is final and I shall abide by the decision.Further, if admitted, I
Promise to abide by the rules and norms of discipline of the Siksha 'O' Anusandhan University.

Date : 22/02/2015

Full Signature of Candidate