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1. (a) Qualifying Degree Examination : ANY BACHELOR DEGREE OF 3/4/5 YEARS DURATION Preserve the Registration Number for
(b) Qualifying Degree Exam Hall Ticket No # : 1432150216 all future correspondence.
(c) Year of App./Passing the Qualifying Exam : 2024 REGISTRATION NO. : 5410138607
(d) Medium of Instruction at Qualifying Exam : English
(e) Place of Study - Intermediate or Equivalent : Urban
2. (a) Candidate's Name # : DEEPIKA MISHRA
(b) Father's Name # : VISHNU MISHRA
(c) Mother's Name : SUNITHA MISHRA
(d) Date of Birth (as per SSC or Equivalent) # : 25/05/2003
(e) Gender : FEMALE
3. Category : OC
4. Local Area : AU
5. (a) Non-Minority / Minority : Non-Minority
(b) Minority Category : N.A
6. Annual Income of the Parents (Rs.) : Below Rs 1 Lakh
7. (a) Study Details :
Class 9 NTR Class 10 NTR
Inter 1st year/Equivalent NTR Inter 2nd year/Equivalent NTR
Degree 1st year NTR Degree 2nd year NTR
Degree 3rd year NTR
(b) Place of Study - SSC or Equivalent : Urban
(c) SSC Hall Ticket Number & Year of Passing : 1912100080 , March - 2019
(d) Inter Hall Ticket Number & Year of Passing : 2005140620 , April - 2022
8. (a) Address for Correspondence : 76-8/7-10/2, JYOTHI CONVENT STREET,
BHAVANIPURAM, Krishna,
ANDHRA PRADESH, 520012
(b) Contact Telephone Number (Mobile) : 7780130053 (c) E-Mail Id : [email protected]
(d) Aadhar Card number : 223128288055
9. Test Centre Preferences
Preference - 1 Preference - 2 Preference - 3
VIZIANAGARAM - Vizianagaram VISAKHAPATNAM - Anandapuram VISAKHAPATNAM - Gajuwaka
Preference - 4 Preference - 5 Preference - 6
VIZIANAGARAM - Rajam VISAKHAPATNAM - Visakhapatnam NTR - Vijayawada
10. (a) Fee particulars - Payment through : ONLINE (c) Amount (in Rs.) : 667.70
(b) Payment Reference Id. : P5410486498E
# - These Fields CANNOT be edited by candidate, but written request can be made to the CONVENER or Regional Coordinator of AP ICET - 2024 or email to [email protected]
Remaining fields can be edited by the candidate during the permitted period. For any details contact at 9000977657.

Declaration : 1) I have carefully gone through the instruction booklet and I am conversant with the instructions. I shall abide by the eligibility conditions
and other regulations to be satisfied for appearing at the entrance test and admission into any course prescribed. Further, I assure that, I will
not involve in any malpractise or illegal activities in the entrance test. In case, I have furnished any false information or involved in any
malpractise or illeagal activities, I am liable for punishment as per the existing law.
2) I am responsible for the corrections of the above details filling by me and the CONVENER AP ICET - 2024 is not responsible in
anyway.
Date : 26/03/2024 05:18 PM
SIGNATURE and LEFT HAND THUMB impression of the candidate to be done in the presence of the Invigilator on
Affix a recent color the day of Examination in the Examination Hall
photograph (3.5 cmX3.5 cm)
and get attested by a SIGNATURE OF THE CANDIDATE
Gazetted Officer or the in the presence of the Invigilator Left Thumb Impression
Principal of the College
where studied (Well in
advance BEFORE
EXAMINATION)

Note : 1) ALL the candidates have to submit this form in the Examination Hall to the Invigilator.
2) Candidates are not allowed into the Examination Hall even if they are LATE BY A MINUTE.
3) This is computer Generated sheet and does not require the signature of the CONVENER, AP ICET - 2024

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