Polytechnic College

THIRUVALLUVAR POLYTECHNIC COLLEGE

First Year Second Year

APPLICATION FORM FOR REGISTRATION

Application No. 20FY -

Admission No.:2020-21 / FY / :

Course :

Civil Engineering

Mechanical Engineering

Electrical and Electronics Engineering

SSLC / Equivalent Total Marks :

NAME :

Name of the Parent / Guardian :

Occupation of the Parent / Guardian :

Annual income of the Parent / Guardian :

ADDRESS:

Pin Code :

Mobile No :

Phone No:

E.mail :

DATE OF BIRTH

Sex :

Female

Male

Third Gender

Nationality

Native District :

Place of Birth :

Mother Tongue :

Religion :

Hindu

Muslim

Christian

Others

If Others,Specify?

Community

SC(A)

MBC & DNC

BC(M)

BC(O)

Certificate Number :

Designation of the Officer who issued the Community Certificate :

Sub Collector

RDO/PA(G)

Tahsildar

Dy.Tahsildar

Name of the Revenue Division :

Name of the Revenue Taluk :

Caste :

Marital Status :

Single

Married

Examination Passed :

SSLC

CBSE

Others

Year of Passing :

Marks obtained in SSLC / Equivalent Examination

Subject	Maximum Marks	Marks Obtained	Month and Year of Passing
Tamil or any other Language	100
English
Mathematics	100
Science	100
Social Science	100
Elective	100
Total	500

Details of Studies :

S.No	Class	Month and Year of Passing	Medium of Instructions	Name of the School and Address
1.	IX Std
2.	X Std

DECLARATION BY THE APPLICANT :

I,.....................................................(Name in full) Son/Daughter of.........................................................hereby solemnly declare that the information furnished in the statements given in the application and the enclosures are true, correct and complete.

Place : ..................

Date : ..................

Signature of the Candidate

Application

APPLICATION FORM FOR REGISTRATION

Marks obtained in SSLC / Equivalent Examination

Details of Studies :

DECLARATION BY THE APPLICANT :

Thiruvalluvar Group of Institutions