APPLICATION FORM ISSUED TO : ___________________

APPLICATION NO :
NOTE : Application should be submitted within 10 days from the date of publication of +2 results
Affix Recent
Passport size Photo
1. Name (in Block Letters)
2. Date of Birth
2a. Place of Birth
2b. Religion
3. Community
[ ] SC/ST [ ] MBC/DNC [ ] BC [ ] OC
4. Mother Tongue
5. Caste
6. Nationality
7. Sex
M / F / TG
8. Aadhaar No. of the Candidate
9. Name of Parent / Guardian
Occupation
Address for Communication
Mobile (Cell)
19. QUALIFYING EXAMINATION PASSED ? HSC OR EQUIVALENT :
SUBJECT MARKS MAXIMUM MONTH / YEAR OF PASSING REGISTER NO. NO. OF ATTEMPTS
PART I : TAMIL100
PART II : ENGLISH100
PART III :
1.
2.
3.
4.		 100
100
100
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: __________________
HSC MARKSCOMMUNITYTRANSFER
CONDUCTSPL. CATEGORY
Challan No: ___________

Date: ___________
Signature of Staff who processed the application: ____________
Signature of head of the department: ____________
HOD Signature
PRINCIPAL