PLEASE DO NOT USE SINGLE QUOTE (') IN ANY OF THE FIELDS. IF USED YOUR APPLICATION WILL NOT REACH US

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 Email : info@kmca.info, website : www.kmca.info

APPLICATION FOR UNDER GRADUATE COMMON ENTRANCE TEST 2025
(For Engineering Courses)

1. CANDIDATE DETAILS

a.   Course Applied For :	Engineering
b.   Exam Centre:	Bangalore Bidar Mangalore Kalaburgi
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?	Muslim Christian Jain Sikh General
ix)  Income & Caste Certificate RD No. :
xi) Are you a resident of Karnataka?	Yes No
xii) If you doesn't belong to Karnataka, which state :
e. Date of Birth :
f. Gender :	Male Female
g. Mailing Address:	City : State: Pincode:
ix)  Aadhaar No :
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 ? Yes No

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