NOTE : Please verify that Form No.

will be same on all the pages like Address Slip, Main Form and Online Payment Receipt.

Address Slip (To be pasted on envelope by Applicant)

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ONLINE APPLICATION FORM FOR (AIEEA - UG - 2018)

By Speed / Registered Post To,

Form No : 1070902
1070902 The Controller of Examinations
From : SWETA MOHANTY (Agril. Edn, COE), Examination
C/O HIMANSU SEKHAR MOHANTY, PLOT Cell, Agricultural Education
NO-1424,NEW FOREST Division, Room No. 216, Indian
PARK,BHUBANESWAR Council of Agricultural Research,
Krishi Anusandhan Bhavan-II,
Khordha , Odisha - 751009 Pusa, New Delhi -110 012
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 INDIAN COUNCIL OF AGRICULTURAL RESEARCH UG
ICAR's 23rd All India Entrance Examination for Admission to Bachelor Degree Programmes and Award
of National Talent Scholarship (AIEEA - UG - 2018) in Agriculture and Allied Subjects other than Veterinary
Science for the
ACADEMIC SESSION 2018-19
Candidate's Name: SWETA MOHANTY Form No.: 1070902

Father's Name: HIMANSU SEKHAR MOHANTY

Mother's Name: CHHABILA PRAVA MOHANTY

Date of Birth: 14/05/1999 1070902

Category: General, PC : No, Blind : No, UPS : No

School Board: Central Board of Secondary Education

State of Domicile: Odisha Exam City: 1. Bhubaneswar, 2. Raipur, 3. Kolkata

Subject Group: Biology

Subjects attempted in the Exam: PCB
Email Id: chhabilamohanty@gmail.com Sex: Female

Mobile: 9437708799 Identification ID: Aadhar No

Nationality: Indian Identification No: 251083502813

Thumb Impression
Place of Residence: City Visible Marks on body: BLACK SPOT ON RIGHT HAND

Type of Institution: Private

Percentage / OGPA of total aggregate marks obtained:
Registration Date: 23/05/2018 20:22:00 Class X: Class XII:
93 78.400
Print Date: 01/08/2018 09:55:20
Subject Taken in Class XII: 1. Physics 2. Chemistry 3. Biology 4. Maths 5. English
Passing Year class XII: 2017
Percentage marks in Class XII: 80.6 % in PCB Group
Percentage marks in English: 75 %
Address: PLOT NO-1424,NEW FOREST PARK,BHUBANESWAR, Khordha , Odisha - 751009

Please Write underlined part of the Declaration Given Below In own Handwriting:

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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)