* indicates required information
Group Name: *
Branch Name of the Qualifying Diploma/B.Sc. Degree Course: *
Differently Abled * Yes No
If differently abled then specify: *
Eminent Sports Persons * Yes No
Children of Freedom Fighters * Yes No
Children of Ex-Servicemen * Yes No
Name in Block Letters(Initials at end): *
Name of Parent/Guardian: *
Permanent Address and Pincode Number:*
Pin Code :
  Same as above address
Address For Communication:*
Pin Code :
Email Id : *
Mobile Number: *
Aadhaar No: *
Sex * Male Female Transgender
Date of Birth : * (DD/MM/YYYY)
Citizenship: * Indian Others
Nativity: * Tamil Nadu Others
Srilankan TamilRefugee: * Yes No
(ST/SC/SCA/MBC-DNC/BC/BC-Muslim/Others) : *
Caste name: *

Diploma/B.Sc.Examination Registration Number:

Details of Institution last studied:
Name of the Polytechnic/College and Address Board/University Discipline of the Qualifying Diploma/Degree

Diploma/ for:

Marks Obtained in Diploma/ Examination:
Semester Month & Year of passing Marks Obtained* Maximum Marks*
1st Semester
2nd Semester
3rd Semester
4th Semester
5th Semester
6th Semester
7th Semester
8th Semester

*Including Theory and Practical Subject.
Overall % of Marks in the qualifying examination:
Whether Mathematics is studied as one of the subject in +2/Degree level:
(for B.Sc candidates only)
Plus Two Degree

Application Registration fee:
Demand Draft No * DD.Amount * Date * Name of Bank,Branch *

Photo / Signature is not uploaded in appropriate place, your application will get rejected

Allowed Photo / Signature Size – 3.5 cm x 4.5 cm (20 KB –40 KB)
Photograph of the Candidate *  
Signature of the Candidate*  

I hereby declare that the details furnished in this application and the attested copies of certificates submitted are true, complete and correct to the best of my knowledge and belief. In case, if the details furnished above by me are found to be incorrect or false at a later date, I am aware that my candidature will be liable to be cancelled without notice. I declare that I shall not raise any objection on this.

Date :
Place :
Security Code *
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