GOVERNMENT OF BIHAR

Bihar Combined Entrance Competitive Examination Board

Online Application Form for Bihar Combined Entrance Competitive Examination (BCECE) -2019
for admission to First Year Degree Courses
Registration No. 2190001957 Please donot send this Hard Copy to BCECE Board
PART- A
1. Course Group Applied For : PCMB

2. Name of Candidate : AMAN KUMAR

3. Father's Name : RAMESH KUMAR

4. Mother's Name : SUMAN DEVI

5. Date of Birth: : 25/ August /2001

6. Gender : Male

7: Reservation Category : EBC (Extremely Backward Class)

8. Disabled Quota : No

9. Mobile No. : 7739995838 Note: Please Affix your same photo and put your full
signature in English and Hindi in spaces provided above.

10. Aadhaar Card No : 413822653156

11. Email ID : amanaryan508@gmail.com

12. Marks of identification : A MOLE MARK ON THE FACE
13. Are You Permanent Resident of Bihar? : Yes
14. Residential Eligibility
:
15. Are you unable to write due to permanent loss of limbs / suffering from : N/A
Cerebral palsy :
16. District Name of the Institute of passing/appearing at I.Sc or equivalent : KHAGARIA
17. Family Annual Income : Less than 8 lakhs
18. Do you claim for Economically Weaker Sections (EWS) ? : N/A
19. Do you claim SMQ Quota : No
20. Are you Son/Unmarried Daughter of Military Personnel? : N/A
21. Percentage of marks obtained in qualifying examination, if Passed:
( Physics+ Chemistry+ Maths+ Biology): 80.50% (English): 85.00%
22. Payment Details:

Payment Mode Journal No. / Transaction No. Deposit Date Amount (in Rs.)
ONLINE BCE5ccbcf505ae60 2019-05-03 10:51:35 Rs. One Thousand One
Hundred
23. Address Details:
A. Permanent Address: B. Correspondence Address:
AT-KHATAHA AT-KHATAHA
GADHMOHANI GADHMOHANI
GOGRI GOGRI
District: KHAGARIA District: KHAGARIA
State: Bihar Pin Code: 851203 State: Bihar Pin Code: 851203
Declaration by the Candidate: I AMAN KUMAR declare that the informations 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)

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 GOVERNMENT OF BIHAR
Bihar Combined Entrance Competitive Examination Board
Online Application Form for Bihar Combined Entrance Competitive Examination (BCECE) -2019
for admission to First Year Degree Courses
Registration No. 2190001957 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-2019 Counseling) BCECE-2019 Counseling) BCECE-2019
Date: Date: Date:

1. Course Group Applied For : PCMB

2. Name of Candidate : AMAN KUMAR

3. Father's Name : RAMESH KUMAR

4. Mother's Name : SUMAN DEVI

5. Date of Birth: : 25/ August /2001

6. Gender : Male

7. Reservation Category : EBC (Extremely Backward Class)

8. Disable Quota : No

9. Mobile No. : 7739995838

Note: Please Affix your same photo and put your full signature
10. Aadhaar Card No : 413822653156 in English and Hindi in spaces provided above.

11. Email ID : amanaryan508@gmail.com

12. Marks of identification : A MOLE MARK ON THE FACE

13. Are You Permanent Resident of Bihar? : Yes
14. Residential Eligibility
:
15. Are you unable to write due to permanent loss of limbs / suffering from : N/A
Cerebral palsy :
16. District Name of the Institute of passing/appearing at I.Sc or equivalent : KHAGARIA
17. Family Annual Income : Less than 8 lakhs
18. Do you claim for Economically Weaker Sections (EWS) ? : N/A
19. Do you claim SMQ Quota : No
20. Are you Son/Unmarried Daughter of Military Personnel? : N/A
21. Percentage of marks obtained in qualifying examination, if Passed:
( Physics+ Chemistry+ Maths+ Biology): 80.50% (English): 85.00%
22. Address Details:

Registration No:2190001957 Printed On: 06-05-2019 14:30:24 Page: 1/3

 A. Permanent Address: B. Correspondence Address:
AT-KHATAHA AT-KHATAHA
GADHMOHANI GADHMOHANI
GOGRI GOGRI
District: KHAGARIA District: KHAGARIA
State: Bihar Pin Code: 851203 State: Bihar Pin Code: 851203
23. Educational Qualification:

Level School/College Name Board/ University Name Passing Status Passing Year
Secondary/Standard
K.B.C.HIGH SCHOOL GAUCHHARI Bihar School Examination Board Passed 2017
X
K.B.C.SR. SECONDRY HIGH
I.S.C./XII (10+2) Bihar School Examination Board Passed 2019
SCHOOL GAUCHHARI
(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 85 100
2 Physics 78 100
3 Chemistry 90 100 85.00% 86.00% 77.33% N/A
4 Maths 90 100
5 Biology 64 100

25. Declaration of the Candidate:

I, AMAN KUMAR Son/ Daughter of RAMESH 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-2019.

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.

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 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-2019 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-2019 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-2019 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

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