/ SRI VENKATESWARA VETERINARY UNIVERSITY
NTR COLLEGE OF VETERINARY SCIENCE ,
GANNAVARAM-521102, KRISHNA DISTRICT

Application for admission into Certificate Course in Poultry Management

2017

1. Full Name in Block Letters :

(As indicated in SSC certificate)

2. Father’s Name :

Mother’s Name :

3. Guardian’s Name & Relationship :

4. Profession of father/husband/guardian :

5. Date of birth, as given in S.S.C./S.S.L.C/H.S.C./

Matriculation Certificate :

(Certificate to be enclosed)

6. Place of Birth: District : State:

7. Nationality : Religion:

8. a) / Social Status
(Certificate to be enclosed) / : OC/SC/ST/BC
(if BC, indicate group )
b) / Sex / : MALE / FEMALE

9.  Address for communication :

Permanent Address / Present (Mailing) Address
PIN CODE
Phone. No.
Mobile No.
E-mail I.D. / PIN CODE
Phone. No.
Mobile No.
E-mail I.D.

10.  Study particulars from IV th class to Xth class (Enclose copies of study certificate)

Class / Year of Study / Name of the school
IV
V
VI
VII
VIII
IX
X

11.  Particulars of previous academic record (Enclose copies of certificates)

Examination Passed / Period of Study / Marks / Percentage / Name of the Board/ University
S.S.C.
Intermediate. (10+2)

Particulars of DD enclosed:

DD NO. and Date Name of the Bank and Branch.

DECLARATION

I promise to abide by the rules/regulations and the orders of the University, its Authorities and Officers. I do hereby declare that the information furnished in this application is true to the best of my knowledge and belief. I am aware that in the event of any information being found to be false or untrue or if I indulge in ragging/misbehave with other Students/Teachers/Staff of the University, I shall be liable to such action taken by the University, as it may deem proper apart from penal action under Law.

Date: ------Signature of the Candidate

Note:

Enclose a crossed Demand Draft for `500/- towards Registration drawn on any Nationalized bank favouring “Certificate Course, Dept. of Poultry Science, NTR CVSc”. Payable at Gannavaram.

Enclose copies of study certificates from IV th to Xth class.

Candidates who passed any examination by private study should furnish residence certificate.

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