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Common Application Form
For Admission to Diploma (2024-25)
Directorate of Technical Education & Training, Odisha
Monday, 22-Jul-2024 1:03:31 PM 24F0165728
No of times CAF edited: 2
Applicant Details
Course Details Diploma in Engineering Only
Applicant's Name Sandeep Kumar Nahak
Father's Name Narendra Nahak
Mother's Name Swarnakanti Nahak
Blood Group B+ Gender MALE
Religion HINDU Date of Birth 07-Sep-2008
Aadhaar Number XXXXXXXX2450
Do you belong to Building & Other Construction Workers (BOC) beneficiary? No BOC Registration No. NA
Address for Correspondence
State Odisha District Ganjam Block/ULB Ganjam
House No., Street/ Village, Post Office Name AT/PO-HARIPURBURUDI,VIA-HUMMA,PS-RAMBHA,DIST-GANJAM
Pin Code 761027 Mobile 9827752833 WhatsApp Mobile No. 9827752833
E-Mail
[email protected] Bank Details
Account No 06810278342 IFSC Code UBIN0804797
Bank Name UNION BANK OF INDIA
Bank Branch RAMBHA Account Holder Name SANDEEP KUMAR NAHAK
10th Examination Details
Exam Name 10th Board /Council Name Board of Secondary Education , Odisha ,Cuttack-01 (year 2001 & onwards)
Board Exam Name High School Certificate Examination Exam Type Annual
Year of Passing 2024 Roll Number 044DB0061 Mark Type Mark
Maximum Mark 600.00 Secured Mark 466.00
Have you passed the Examination Compartmentally ? No Mark Secured In First Attempt --
SL# Subject Maximum Mark Secured Mark Compartmental Mark Secured in first attempt Percentage
1 Second Language 100 73 No -- 73.00
2 Social Science 100 73 No -- 73.00
3 Science 100 76 No -- 76.00
4 Mathematics 100 84 No -- 84.00
5 Third Language 100 84 No -- 84.00
6 First Language/ Odia 100 76 No -- 76.00
Domicile
Are you Odisha State Applicant (S) ? Yes
Are you Outside Odisha State Applicant (Z)? No
Are you Odia Living in outlying Odia Speaking Tracts (L)? No
Reservation Details (Reservation is applicable only for "S" domicile Applicants)
Category Other
Physically Challenged(PC) NA Children/Wards of Ex-servicemen (ES) NA
Sports NA National Cadet Corps (NCC) NA Orphan NA
Other Information
Nationality Indian Annual Income Upto 2.5 lakh
TFW Scheme No
Do you belong to Economically Weaker
No
Sections (EWS) category?
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Option Details
SL# Admission Type Option No College Name Branch Name
1 Govt. Polytechnic, Berhampur COMP. SCIENCE
1 Fresh
2 Uma Charan Patnaik Engg. School, Berhampur COMP. SCIENCE
Payment Details
Mode of Payment Payment Status Amount Paid Transaction No.
Online SUCCESS 300.00 YUR32332006505
Enclosures (Certified True Copy of the following documents must be enclosed along with the CAF)
Sl# Documents
1 Original Certificate of HSC examination /10th standard examination declared equivalent by BSE, Odisha
2 Original Mark sheet of HSC examination /10th standard examination declared equivalent by BSE, Odisha
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