Application Form

Personal Information

Name
Date of Birth
Age
Place of Birth
Nationality
Religion
OC        BC        MBC        SC/ST
Caste
Blood Group
Mother Tongue
Aadhar No.
Qualifying Examination Passed, H.Sc., or Equivalent
   Are you a first generation Learner                Yes No

   Are you Differently Abled, If so specify          Yes No

Specify
   Are you a Daughter of an Ex-Service man    Yes No

Achievements in NCC/NSS Distinction in Sports (District/State/National)

Particulars of marks


H.Sc.    CBSE    Other State    
Year & Month Reg No Subject Max. Marks Marks Obtained No. of Attempts
Total


Name and Location (District) of School studied
Medium of Instruction in XII

Course applied for:-

Shift 1 (9:00 am. to 2:15 pm.)

B.A Tamil B.A English
B.Sc Biochemistry B.Sc Computer Science
B.Sc Mathematics BBA
BCA B.Com General
B.Com ISM B.A Economics
B.Sc Physics with Computer Applications B.A Tourism and Travel Management
B.Sc Psychology

Shift 2 (12:00 pm. to 5:00 pm.)

B.Com Corporate Secretaryship B.Sc Computer Science
B.Com Accounting and Finance B.A Historical Studies
B.A Sociology


11th Mark Sheet
12th Mark Sheet
Upload Recent Passport Size Photo

Details of Parents / Guardian

Father / Mother / Guardian Name
Occupation
Income(Yr)
Off. Address
Mobile No.
Email Id.
Father / Mother / Guardian Photo
Permanent Address
Address for Communication

BANK NAME AXIS BANK LTD, AMBATTUR, CHENNAI-600053
IFSC CODE UTIB0000865
ACCOUNT NO 916020073286619
Kindly pay the application fee Rs.200/- to the above account and enter the Transaction ID below.
Transaction ID