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Common Application Form for e-Admission to Junior Colleges in the State of Odisha Department of Higher Education Government of Odisha Satyabhama Devi College of Hearing Impaired Bhubaneswar This CAF is only for Satyabhama Devi College of Hearing Impaired Bhubaneswar. This can not be used for any other college. For official use only Money Receipt-cumIndex Number Option Fees 19055160 / Date of Submission at College Barcode Number will be generated after entering this CAF into the e-Space software 10th Board Details Signature of the Receiving Official Name of the Examination Board Year of Passing Roll Number As in admit card Applicant s Name Affix your self attested on the front recent colour passport size photograph here Full Name Father s Name 5 Personal Details Blood Group Sex M/F Religion Date of Birth 6 Address for Correspondence a* State d. c* Block/ ULB b. District Details Plot / Lane / Vill /PO / PS e. PIN Code f* Telephone h. e-mail g. Mobile 7 Reservation Details Please a in appropriate box a* Scheduled Tribe ST Scheduled Caste SC c* Ex-Service Man ESM Serving Defence Personnel SDP b. Others Children of Martyrs CoM Yes e. Are you an Odia Living in Neighbouring State OLNS No If yes please give the State Name Are you an Outside State Applicant OSA Physically/Orthopedically Handicapped PH/OH 8 Weightage Details Please a in appropriate box NCC Scout Guide Rajya Puraskar RP President Recognition PR Sports National International 9 Details of marks secured in 10th Board Examination Maximum Marks Marks secured in subjects a* specified in 10th Board Examination Have you passed 10th Board Exam Compartmentally Total Marks Secured English Mathematics previous exam Name of the Subject If yes Science Social Science Compartmental exam 10 Option s /Choice s Details First Option a* Stream Name b. Compulsory MIL Elective Subject First Elective Second Elective Third Elective 4th First Preference Second Preference Third Preference Are you interested to reside in hostel UNDERTAKING I do hereby agree to abide by the rules of the College/Hostel* I undertake that should any instance of indiscipline and disobedience of the rules laid down by the Government or any authority empowered by them in this regard or should my conduct in the college is found not satisfactory my name will be automatically be removed from the college. I also undertake that the information furnished by me in this application is true and correct. Should any information furnished by me is detected wrong afterwards it will be treated as cognizable offence. I further undertake that I will not involve in any ragging activities in the College and hostel premises. I understand that criminal case will be filed against me if I indulge in ragging. I hereby fully endorse the undertaking made by our child/ward Signature or thumb impression of parents/ guardian Date Place Submitted by me Full Signature of Applicant. This can not be used for any other college. For official use only Money Receipt-cumIndex Number Option Fees 19055160 / Date of Submission at College Barcode Number will be generated after entering this CAF into the e-Space software 10th Board Details Signature of the Receiving Official Name of the Examination Board Year of Passing Roll Number As in admit card Applicant s Name Affix your self attested on the front recent colour passport size photograph here Full Name Father s Name 5 Personal Details Blood Group Sex M/F Religion Date of Birth 6 Address for Correspondence a* State d. c* Block/ ULB b. District Details Plot / Lane / Vill /PO / PS e. PIN Code f* Telephone h. e-mail g.

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