1. Name (in BLOCK LETTERS): 

2. Sex                                            : Male Female

3. Date Of Birth                           :  02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001 2002 2003 2004 2005 2006 2007 2008 2009   Age :

4. Nationality                               :  

5. a) Religion                               :     b) Cast              :   

6. Community                              :  SC ST  MBC DNC BC FC

7. Father's / Mother's Name      :     8. Occupation   :  

9. Annual Income                        :   Rs

10. Permanent Address              :  

                                                        

                                                        

                            DISTRICT      :      STATE     :

                                                         PIN              PHONE   :

11. Communication Address    :    

                                                        

                                                        

                           DISTRICT    :         STATE     :   

                                                         PIN              PHONE   :  

                                 E-mail      :     

 12. Academic Qualification    :

                           UG Reg.No   :     

                                   Degree  :         Branch   :   

        Medium Of Instruction   :         Name Of The Institution     : 

                              University  :        Month & Year Of Passing   :    

12.a) Academic Performance : 

    Part    Marks Obtained      Max.marks(Total)     Percentage           Class

      I                       FIRST SECOND THIRD

      II                        FIRST SECOND THIRD

    III                      FIRST SECOND THIRD

13. Extra-Curricular Activities (NCC/NSS/Sports/Others):   

14. Whether Eligiblity Certificate Produce                         :     Yes   No

                             If YES ,Eligibility Certificate No            :    

15.Whether Passed In The First Attempt                           :     Yes    No

                                         If NO , No.of Attempts               :      

16. Whether Hostel Accommodation Is Required              :     Yes   No

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DECLARATION

I declare that the particulars furnished herein are correct and true to the best of my knowledge and belief. If admitted, I will abide by the rules and regulations of the College

Station: 

 

Date   : 

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Note: 1.Incomplete application will be summarily rejected

              2. Candidates from other State/University and from Annamalai and Manonmaniam Sundaranar

              Unversity should produce necessary eligibility certificate from Bharathiar  University, Coimbatore.

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Page designed by

1. P.Mohan Raj ( III MCA)

2. M. Karthi (II MCA)

3. P.Santhosh (II MCA)

4. N.Senthil Kumar ( II MCA)

5. P. Manikandan (II MCA)

6. M. Balaji (II MCA)