KARNATAKA RELIGIOUS & LINGUISTIC MINORITY
PROFESSIONAL COLLEGES ASSOCIATION (REGD.)
(KRLMPCA)

Flat No.143, 4th Floor,'SURYAMUKHI', GardenApartments,
#21, Vittal Mallya Road, Bangalore – 560 001.
Ph.: 080 – 4112 1233 Fax: 080-4112 1266 Email : info@kmca.info, website : www.kmca.info

APPLICATION FOR UNDER GRADUATE COMMON ENTRANCE TEST 2018-19
(ENGINEERING)

1. CANDIDATE DETAILS
a.   Course Applied For :
b.   Exam Centre:
c.   Name       :
d
  i)   Father’s / Guardian's Name :
  ii)   Father’s / Guardian's Occupation :
  iii)   Father’s / Guardian's Income : Rs.
  iv)   Mother’s Name :
  v)   Mother’s Occupation :
  vi)   Mother’s Income : Rs.
  vii)   Religion:
  viii)   Community :
  ix)  Mothertongue :
  x)  Do you belong to any of the Minority?
  xi) Are you a resident of Karnataka?
  xii) If you doesn't belong to Karnataka, which state :
e. Date of Birth :
f. Gender :
g. Mailing Address:

City :
State:
Pincode:
h. Photo:


i. Telephone j. Mobile Number k. Email Address

2. Academic Details

a) X STD / SSLC / SSC or equivalent 
Name of the School State Year of Passing
a) XII STD / PU / 10+2 or equivalent 
Name of the College State Year of Passing

c. Marks obtained in PU or Equivalent

Subject Max. Marks Marks obtained Percentage
Physics
Chemistry
Maths
English
Average of PCM

d. Results Awaited ?

Enclose the following photocopies of certificates (Attestation NOT REQUIRED)

  1.  II PUC Marks Card (if results are not declared please indicate “RESULTS ARE AWAITED”)
  2.  Proof of Date of Birth
  3.  DD for Rs.1000.00 drawn in favor of KRLMPCA payable at Bangalore
  4.  One additional photograph to be enclosed with the above documents

I solemnly and sincerely affirm that the above information furnished by me is true and correct. LEGAL JURISDICTION BANGALORE - KARNATAKA


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