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1. (a) Qualifying Degree Examination : Any Bachelor Degree of 3 Years Duration Preserve the Registration Number for
(b) Qualifying Degree Exam Hall Ticket No # : 5035101011210014 all future correspondence.
2024 REGISTRATION NO. : 551028506B3
(c) Year of App./Passing the Qualifying Exam :
(d) Medium of Instruction at Qualifying Exam : English
(e) Place of Study - Intermediate or Equivalent : Urban
2. (a) Candidate's Name # : MANGIPUDI VENKATARAMANA
(b) Father's Name # : MANGIPUDI KAMESWARA RAO
(c) Mother's Name : MANGIUPDI UDAYA
(d) Date of Birth (as per SSC or Equivalent) # : 23/03/2002
(e) Gender : MALE
3. (a)Category : OC
(b) Sub-Caste : brahmin
4. Local Area : OTHER STATE
5. (a) Non-Minority / Minority : Non-Minority
(b) Minority Category : N.A
6. Annual Income of the Parents (Rs.) : Above Rs 2.5 Lakhs and below Rs 8 Lakhs
7. (a) Study Details :
Class 9 Anakapalli Class 10 Anakapalli
Inter 1st year/Equivalent East Godavari Inter 2nd year/Equivalent East Godavari
Degree 1st year OTHER STATE Degree 2nd year OTHER STATE
Degree 3rd year OTHER STATE
(b) Place of Study - SSC or Equivalent : Urban
(c) SSC Hall Ticket Number & Year of Passing : 1739102488 , May - 2017
(d) Inter Hall Ticket Number & Year of Passing : 1903215368 , March - 2019
8. (a) Address for Correspondence : ROAD NO3 CROSS ROAD 7 HEMANSHU MENS
HOSTEL, KPHB,
KUKATAPALLY,MEDCHAL,
TELANGANA, 500072
(b) Contact Telephone Number (Mobile) : 7675826449 (c) E-Mail Id : [email protected]
(d) Aadhar Card number : 379100331971
9. Test Centre Preferences
Preference - 1 Preference - 2 Preference - 3
VISAKHAPATNAM - Visakhapatnam VISAKHAPATNAM - Gajuwaka VISAKHAPATNAM - Anandapuram
Preference - 4 Preference - 5
VIZIANAGARAM - Rajam VIZIANAGARAM - Vizianagaram
10. (a) Fee particulars - Payment through : ONLINE (c) Amount (in Rs.) : 667.70
(b) Payment Reference Id. : P55113332084
# - These Fields CANNOT be edited by candidate, but written request can be made to the CONVENER or Regional Coordinator of AP ICET - 2025 or email to [email protected]
Remaining fields can be edited by the candidate during the permitted period. For any details contact at 0891-284 4992, 0891-2711744.

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 - 2025 is not responsible in
anyway.
Date : 08/04/2025 09:39 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 - 2025

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