FT/A2/02

SRI VENKATESWARA COLLEGE OF ENGINEERING

PENNALUR, SRIPERUMBUDUR – 602 105.

STUDENT-DATA

(I year M.E./M.Tech / MCA)

FOR OFFICE USE ONLY

Quota / Branch
Admission No. / Admission Date

Name

(IN BLOCK LETTERS)

Expansion of Initials

Date of Birth and Age 2006

(as on 01/07/2012)

Day Month Year Age

Gender

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 / Others
Community / OC / BC / MBC / DNC / SC / SCA / ST
Name of the Caste & Code
Community certificate number & date
Authority by whom issued community certificate issued
Name of the Degree and Discipline passed & year of passing
Name of the University
Name of the College and address
University Register No.
Year of Passing
Medium of Instruction

Educational Qualifications

Degree / Discipline / Name of the College / University / Subject / % of Marks / Class / Division
Main :
Allied : / MCA ( I – VI sem)
M.E ( III to VIII sem)
Total Marks / Maximum Marks
SSLC / CBSE / Matric / SSLC / ICSE / Others (mention the board)
HSC / HSC – A / HSC-V / BIO / BOK /ICSE / CBSE / Others (mention the board)
Diploma / Discipline :
U.G
MCA ( I – VI sem)
M.E ( III to VIII sem) / B.E./B.Tech / M.Sc. / B.Sc / MCA / B.Com / Others (mention the board)

Whether Mathematics is one of the subject at +2 or degree level : YES / NO

Consortium Application Number
Consortium Marks
TANCET Application Number
TANCET Register Number
TANCET Marks
Overall Rank
Community Rank
Provisional certificate number & date
Mark sheet / Certificate No. and Date
Transfer certificate number & date
Community certificate number & date
Name of the sponsoring organization (if applicable)

Particulars of Parent / Guardian

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

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.
e-mail address
Guardian Address
Name
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 :
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

DETAILS OF INITIAL AMOUNT PAID DURING COUNSELLING (FOR Govt Quota CANDIDATES ONLY)

Admission No. / Bank Challan No. / Date / Amount paid Rs.
Rs. 5000 /-
or
Rs.1000/-

FEES CHALLAN DETAILS

CHALLAN No. / DATE / AMOUNT
TUITION FEE
TRANSPORT FEE / Rs. 24,000/-
HOSTEL FEE

Place:

DATE : SIGNATURE OF THE STUDENT

FOR OFFICE USE ONLY

Govt Quota / GENERAL / MINORITY / SPONSERED / LAPSED

Quota

Transport Dept. : Route No. Boarding Point

Hostel : Room No. allotted:

I Year Batch : Roll No.

Verified by (Name and Signature) : .Academic Officer