APPLICATION NO : / 2020-2021
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B.Sc., Bio-Chemistry / Micro Biology / Computer Science / Information Technology /
B.Sc., Maths with Computer Applications / B.Sc., Physics / B.C.A., / B.Com.,(Computer Applications) / B.Com., / B.A., Tamil
(Self - Finance U.G. Courses) (2020 - 2021)

The entries in the Application should be filled in by the applicants only in their own handwriting which should be legible. Typed entries will not be accepted.

1. NAME : தமிழ் :
English :
2. PLACE OF BIRTH & DISTRICT : 2a. SEX : Male / Female / Transgender
2b. DATE OF BIRTH :
2c. Age :
3. COMMUNITY :    SC / ST [   ]    MBC / DNC [   ]    BC [   ]    OC [   ]
4. NATIONALITY : 4a. RELIGION :
5. MOTHER TONGUE : 6. CASTE :
7. AADHAAR No. OF THE CANDIDATE :
7a. NAD ID : 7b. PAN No. :
8. Blood Group :
9. NAME OF PARENT / GUARDIAN (STATE RELATIONSHIP) :
Father / Guardian :    Mother :
Mobile No. :    Mobile No. :
12. ADDRESS FOR COMMUNICATION


PIN
Cell : +91
e-mail id : 		12a. PERMANENT ADDRESS


PIN
Cell : +91
e-mail id :
13. IF PHYSICALLY HANDICAPPED, SPECIFY : YES / NO 14. ARE YOU SON / DAUGHTER OF EX-SERVICE MAN OF TAMILNADU ORIGIN : YES / NO
15. ARE YOU OF TAMIL ORIGIN FROM ANDAMAN NICOBAR ISLANDS? YES / NO 16. DISTINCTION IN SPORTS / NCC / NSS : YES / NO
17. NAME & LOCATION (DISTRICT) OF SCHOOL LAST STUDIED :
18. HAS THE APPLICANT RECEIVED PRICELESS LAPTOP FROM GOVERNMENT?   YES   /   NO
19. HAS THE APPLICANT PASSED IN THE FIRST ATTEMPT ITSELF?             YES   /   NO
20. EMIS No. :

21. QUALIFYING EXAMINATION PASSED ? HSC OR EQUIVALENT :

SUBJECT MARKS MAXIMUM MONTH / YEAR OF PASSING REGISTER NO. NO. OF ATTEMPTS
PART I : TAMIL 100
PART II : ENGLISH 100
PART III : 1. 100
PART III : 2. 100
PART III : 3. 100
PART III : 4. 100
★ TOTAL 600

★ Enclose Xerox copy of +1, +2 Mark Sheets

Declaration : I DECLARE THAT ALL THE PARTICULARS FURNISHED ABOVE ARE TRUE AND CORRECT. I SUBMIT THAT I WILL ABIDE BY THE RULES AND REGULATIONS OF THE COLLEGE.
PLACE:
DATE:
SIGNATURE OF PARENT / GUARDIAN
SIGNATURE OF APPLICANT
FOR OFFICE USE ONLY

CERTIFICATES VERIFIED : ADMITTED To ________________

T.C. HSC MARKS COMMUNITY
CONDUCT SPL. CATEGORY PHOTO
SIGNATURE OF STAFF WHO PROCESSED THE APPLICATION : ...........................................

SIGNATURE OF HEAD OF THE DEPARTMENT : ................................................................
Challan No. : ...........................
Amount Rs. : ...........................
Date : ...........................
PRINCIPAL