FT/A2/02

SRI VENKATESWARA COLLEGE OF ENGINEERING

PENNALUR, SRIPERUMBUDUR Tk. – 602 117.

BIO-DATA CUM APPLICATION FORM

(I year B.E./B. Tech.)

2015-2016

Branch Alloted : Admission No:

Name

(IN BLOCK LETTERS as per

+2 Mark sheet )

Expansion of Initials

Date of Birth and Age 2006

(as on 01/07/2015)

Day Month Year Age

Sex

Address for Communication
Door/Plot/Flat No.
Street
Town
City
State
Pin code
STD code
Phone No.
Mobile No.
e-mail address
Native place
Mother Tongue
Religion
Citizenship / Indian / Other
Community / OC / BC / BCM / MBC / DNC / SC / SCA / ST
Community Code / 7 / 5 / 6 / 4 / 4 / 2 / 3 / 1
Name of the Caste
Community certificate number & date
Authority by whom issued community certificate issued
Minority certificate number & date
(only Management students)
Authority by whom Minority certificate issued
S.S.L.C (10th) / S.S.L.C / C.B.S.E / MATRIC / ANGLO / OTHERS
Marks obtained / Maximum Marks
H.S.C (+2) / HSC
Academic / HSC Vocational / CBSE / ISCE / BOI / OTHERS
Marks obtained
Marks obtained
Medium of Instruction
Name of the State Board which issued the Certificate (+2)
Name of the School last studied and address

Number of appearances made:

If more than one appearance details of appearance:

Appearance / Register Number / Month & Year
First
Second
Third

Marks Details:

Subject / HSC (A) / CBSE/OTHERS / BOI / HSC (VOCATIONAL)
ENGLISH / /200 / /100 / /150 / ENGLISH /200
MATHS / /200 / /100 / /300 / MATHS /200
PHYSICS / /200 / /100 / /150 / THEORY /200
CHEMISTRY / /200 / /100 / /150 / PRACTICAL I /200
PRACTICAL II /200
Transfer certificate number & date
Conduct certificate number & date

Mark sheet details for

HSC Academic / Vocational / BOI and others /

XII Mark sheet details for CBSE/ISC

Item / Number & Date / Item / Number & Date
Month & year of passing / Month & year of passing
Certificate No. / Pass Certificate
TMR Number / Mark Certificate
Register Number / Register Number

Particulars of Parent / Guardian

(Information on guardian may be provided only if both parents are not alive)

Father / Mother
Name
Name of the Company / Organization
Designation / Occupation
Office Address / Permanent Address
Door/Plot/Flat No
Street
Town
City
State
Pin code
STD code
Phone No
Mobile No (for sending SMS)
e-mail address
Guardian Address
Door/Plot/Flat No
Street
Town
City
State
Pin code
STD code
Phone No
Mobile No
e-mail address
Parent’s / Guardian’s Qualification
(State the Degree and Discipline) / Father :
Mother :
Annual Income (Parent / Guardian) : Rs / Father :
Mother :
Consortium Application Number & Rank number (for Management Students)
TNEA Application Number
(For Dote Students only)
Cut off marks (out of 200)
RANK / Overall Rank
Community Rank
TNEA Admission order number & date (For Dote Students only)
TNEA acknowledgement details (For Govt Students only) / Receipt No. / Date / Amount - Rs.
5000 / 1000
Are you claiming for first graduate fees concession / YES / NO
If yes furnish certificate number, date & issued by whom
Name of the Scholarship and amount received, if any and the awarding authority
Name of the Sports/Games in which proficient
Level of Participation / National / State / District / School
Student's Blood group
Willing to Donate Blood / Yes / No
Details of relatives studying / studied in this College
I have chosen SVCE because of

I hereby declare that the above particulars furnished by me in this application are correct.

DATE : SIGNATURE OF THE STUDENT

FOR OFFICE USE ONLY

Quota / Govt – General / FG/ Sports / Differently abled persons / Vocational/ GFW
Mgmt - General / Minority / NRI
Branch /

AUTO / CSE / EEE / ECE / MAR / MECH / CHEM / IT / BT / CIVIL

Sex / Male / Female / Community / OC/ BC / BCM / MBC / DNC / SC / SCA / ST
Admission No. / 2015 / / / Admission Date / / / 2015
Transport Dept
/ Route No. / Boarding point
Hostel Office
/ Room No. allotted
.Fees paid details / Challan No. / Date / Amount (Rs.)
Tuition Fees
Transport / Hostel Fees

Verified by (Name and Signature) : Academic Officer