2/4/2014 Application Form

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Address Slip (To be pasted on envelope by Applicant)

ONLINE APPLICATION FORM FOR(AIEEA-UG-2014)
To,
The Controller of Examinations
(Edn.),
Exam Cell, Education Division,
ICAR,
Room No. 216, Krishi
Anusandhan Bhavan-II,
Pusa, New Delhi -110 012
By Speed / Registered Post
Form No :-438997
From :: NANCY SIDDHARTH(438997)
BLOCK NO.43/2/3,ROAD NO.2, BAGBERA
HOUSING COLONY,,
TATANAGAR, JAMSHEDPUR,
Jharkhand - 831002

2/4/2014 Application Form
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INDIAN COUNCIL OF AGRICULTURAL RESEARCH
UG
ICAR's 19th All India Entrance Examination for Admission to Bachelor Degree Programmes and
Award of National Talent Scholarship (AIEEA-UG-2014) in Agriculture and Allied Subjects other
than Veterinary Science for the
ACADEMIC SESSION 2014-2015
Candidate's Name: NANCY SIDDHARTH
Father's Name: GOURI SHANKAR MISHRA
Mother's Name: PUSHPA MISHRA
Date of Birth: 01/05/1996
Exam City Center: 37 - RANCHI
School Board: Central Board of Secondary Education
State of Domicile: Jharkhand
Subject Group: Biology Stream:
A - Agriculture /
Biology
Category: GEN Sex: Female
Phone: Mobile: 8238082767
Nationality: INDIAN
Place of
Residence:
Town
Paper Medium: ENGLISH
Type of Institution: Private
Percentage of total aggregate marks obtained:
Class X: 78%
Class XII: 58%
Form No. 438997
Signature of Student
Right Thumb Impression
Subject Taken in Class XII: 1. Physics 2. Chemistry 3. Biology 4. English
Yr. of Passing /appearing class XII: 2013
Percentage marks in Class XII in PCB: 58%
Percentage marks in English 56%
Address:
BLOCK NO.43/2/3,ROAD NO.2, BAGBERA HOUSING COLONY,, TATANAGAR, JAMSHEDPUR,
Jharkhand - 831002
Mode of Payment: Through Online Payment Gateway
Please Write underlined part of the Declaration Given Below In own Handwriting


Declaration: I hereby solemnly affirm that all the particulars stated by me in this Application are true and correct. I have not concealed any information.
However, if any information furnished here in is fraudulent, incorrect or untrue, I understand that I am liable to criminal prosecution and I also agree to
forego my admission. Further that the selection and admission to the course is liable to be cancelled at any time during the entire degree program. I agree to
abide by the rules and regulations governing the examination as contained in the Information Bulletin, which I have duly studied and understood
thoroughly.
Date:
Signature of the candidate in running hand (NOT IN CAPITAL
LETTERS)
I have fully read the information furnished by my son / daughter / ward and affirm that it is true and if it is found at any stage that the information is
fradulent, I am liable to criminal prosecution.
Date............................ Place........
Signature of Father / Mother / Guardian (*If Father and Mother not
alive)
2/4/2014 Application Form
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OFFICE COPY
ADMIT CARD
(To be submitted along with Application positively)
Application Form No. 438997
INDIAN COUNCIL OF AGRICULTURAL RESEARCH
Krishi Anusandhan Bhavan-II, Pusa, New Delhi-110012
19th ALL INDIA ENTRANCE EXAMINATION FOR ADMISSION TO BACHELOR DEGREE PROGRAMMES IN
AGRICULTURE AND ALLIED SCIENCE SUBJECTS (OTHER THAN VETERINARY SCIENCES) AND AWARD OF
NATIONAL TALENT SCHOLARSHIP FOR THE ACADEMIC SESSION 2014-15
Roll No:

STREAM:
A - Agriculture /
Biology
Optional Subject: ..................................
Paste your recent passport
size color photograph (3.5 x
4.5 cm)
To be attested by
Principal/Gazetted Officer
Name and Address of Candidate
NANCY SIDDHARTH
BLOCK NO.43/2/3,ROAD NO.2
BAGBERA HOUSING COLONY,,TATANAGAR
JAMSHEDPUR,Jharkhand
Date of Exam:12.04.2014 (Saturday)
Duration: 10:00 AM to 12:30 PM (2 hours)
Reporting Time: 09:30 AM
No Entry After: 10:30 AM
Cannot Leave Before: 12:30 PM
Name of the City of Examination : RANCHI
Venue :


Thumb Impression Signature of the Candidate Controller of Exams (Edn)

CANDIDATE COPY
(TO BE RETAINED BY THE CANDIDATE)
ADMIT CARD
Application Form No.
438997
INDIAN COUNCIL OF AGRICULTURAL RESEARCH
Krishi Anusandhan Bhavan-II, Pusa, New Delhi-110012
19th ALL INDIA ENTRANCE EXAMINATION FOR ADMISSION TO BACHELOR DEGREE PROGRAMMES IN
AGRICULTURE AND ALLIED SCIENCE SUBJECTS (OTHER THAN VETERINARY SCIENCES) AND AWARD OF
NATIONAL TALENT SCHOLARSHIP FOR THE ACADEMIC SESSION 2014-15
Roll No:

STREAM:
A - Agriculture /
Biology
Optional Subject: ..................................
Paste your recent passport
size color photograph (3.5 x
4.5 cm)
To be attested by
Principal/Gazetted Officer
Name and Address of Candidate
NANCY SIDDHARTH
BLOCK NO.43/2/3,ROAD NO.2
BAGBERA HOUSING COLONY,,TATANAGAR
JAMSHEDPUR,Jharkhand
Date of Exam:12.04.2014 (Saturday)
Duration: 10:00 AM to 12:30 PM (2 hours)
Reporting Time: 09:30 AM
No Entry After: 10:30 AM
Cannot Leave Before: 12:30 PM
Name of the City of Examination : RANCHI
Venue :


Thumb Impression Signature of the Candidate Controller of Exams (Edn)
2/4/2014 Application Form
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Entrance Exam (AIEEA-UG-2014) Fee Deposit Challan Entrance Exam (AIEEA-UG-2014) Fee Deposit Challan
(Candidate's Copy) (ICAR's Copy)
ICAR, Education Division, KAB-II, Pusa, New Delhi
Academic Year 2014-15
Syndicate Bank
Exam Fee Paid:
Under-graduate (UG) Programme:
GEN Category 500
Bank Commission: 0
Total Fee Paid: 500
Transaction ID No.: MSPD3245806659
Particulars of Candidate
ONLINE Application Form No.: 438997
Name: NANCY SIDDHARTH
Father`s Name:
GOURI SHANKAR
MISHRA
Address:
BLOCK NO.43/2/3,ROAD
NO.2, BAGBERA HOUSING
COLONY,, TATANAGAR,
JAMSHEDPUR, Jharkhand
Phone/ Mobile No.: 8238082767
ICAR, Education Division, KAB-II, Pusa, New Delhi
Academic Year 2014-15
Syndicate Bank
Exam Fee Paid:
Under-graduate (UG) Programme:
GEN Category 500
Bank Commission: 0
Total Fee Paid: 500
Transaction ID No.: MSPD3245806659
Particulars of Candidate
ONLINE Application Form No.: 438997
Name: NANCY SIDDHARTH
Father`s Name:
GOURI SHANKAR
MISHRA
Address:
BLOCK NO.43/2/3,ROAD
NO.2, BAGBERA HOUSING
COLONY,, TATANAGAR,
JAMSHEDPUR, Jharkhand
Phone/ Mobile No.: 8238082767