2017510 RIECEE2017

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NCERTCommonEntranceExamination(CEE)2017
ApplicationForm

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2017510 RIECEE2017

State/UTof UTTARPRADESH PROGRAMME RegistrationNo.

Bonafide
B.Ed. 2017030026
(Domicile)
ProgrammeGroup SubGroup
Exam C1:ALLAHABAD,C2:LUCKNOW,C3
B.Ed. B.Ed.(LAndSS)
:PATNA
Center's
University/Board Passed/Appearing
Eligibilityfor RIEAjmer
BANARASHINDU Appearing
Admissionin UNIVERSITY

Candidate No Year ThirdLanguage

belongsto 2017 Sanskrit

Hyderabad Prarambh
Karnataka
No
Candidate's RAJANISHTRIPATHI NTSEawardee? Yearofaward
Name:
No

Father's SHAMBHUNATHTRIPATHI Signatureofthe

QualifyingExam
Name: Candidate
BachelorinSocialScience/Humanities

Mother's PRATIMATRIPATHI Mobilenumber Emailaddress

Name:
8601136901 rajanish115@gmail.com
CandidateMailingAddress Category DateofBirth
Address:VILLTIWARIPURPOST
GM 15/07/1996
SAJOIDISTVARANASI
Gender PersonWithDisability
City/Town/VARANASI
Village: Male No

District:VARANASI DisabilityType PH(VisuallyImpaired)

State:UTTARPRADESH

PinCode:221302
STDCodePhoneNumber:
CandidatePermanentAddress
StateProof:1.Evidenceofhavingpassed
Address:VILLTIWARIPURPOSTSAJOIDIST thequalifyingexamination.............
VARANASI

City/Town/VARANASI
Village:
District:VARANASI
State:UTTARPRADESH
PinCode:221302

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2017510 RIECEE2017

Disclaimer
Iherebydeclarethatalltheinformationprovidedbymeinthisapplicationaretrue,completeand
correcttothebestofmyknowledgeandbelief.Intheeventofmyinformationbeingfoundfalseor
incorrectortheineligibilitybeingdetectedbeforeoraftertheCommonEntranceExamination
(CEE)2017/Admission,actioncanbetakenagainstmebytheNCERT/RIEs.Ihavereadthe

provisionsoftherelevantrulesandtheadvertismentcarefullyandIherebyundertaketoabideby
them.IfurtherdeclarethatIfulfillalltheconditionsofeligibilityprescribedfortheadmissioninRIEs
ofNCERT.AlsoIacceptSMSfacilityprovidedbytheNCERT/RIEs.

(ApplicantSignature)

RIEMysuru Printedon:1005201700:20:28 IpAddress:10.11.11.174

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