0% found this document useful (0 votes)
54 views2 pages

Khadir Mohideen College

Download as pdf or txt
Download as pdf or txt
Download as pdf or txt
You are on page 1/ 2

KHADIR MOHIDEEN COLLEGE

[CO-EDUCATION]
[NATIONALY RE-ACCREDITED WITH B GRADE BY NAAC]
[AFFILIATED TO BHARATHIDASAN UNIVERSITY, TRICHY]
ADIRAMPATTINAM-614 701, THANJAVUR(Dt)

APPLICATION FORM FOR ADMISSION


AIDED COURSES(PG)
Degree:M.Sc. Application No: PG-OLA-00001
Major:Zoology Registration No:
Paid ID: MOJO1708905A56720280
Paid Amount:
65.67

1. Name: SARANYA C

2. Date of Birth: 09/02/1989

3. Father's Name: M. Chinnathambi

4. Father's Occupation: Farmer

5. Mother's Name: Kalaiselvi

6. Mother's Occupation: Farmer

5. Guardian's Name:

6. Guardian's Occupation:

7. Gender: Female

8. Contact Number(Mobile): 7502995456

9. Nationality: Indian

10. Religion: Hindu

11. Community: DNC

12. Caste: Ambalakaran

13. Annual Income: 60000

14. Aadhar Number: 435791745542

15. Bank Account Details: State bank of india, peravurani

16. Permanent Address: No:463,. Kondraikkadu, kalagam(po), Peravai rani(tk), Thanjavur dist. Pin

17. Physically Challenged? : No Details(if yes) :

18. Son/Daughter of Ex.serviceman of Tamilnadu Origin? : No


Troupe No. & Rank (if yes) :

19. Are you employed? : No Details(if yes) :


20. Name & Address of the College last studied: Rajah serfoji government college (Autonomous)

21.Name of the affiliated University : Bharathidasan university

22.Qualifying Examination Passed/Appeared : B.Sc. Zoology

23.Month & Year of Passing/appearing : April 2012 Year of Study : 2009

24.Percentage of marks in Part-III(upto 5th semester):

25.Percentage of marks in Part-III(upto 6th semester): 83.25%

26.Mark Statement

Subject Marks Sec. Max Marks Percentage


Part I 282 400 7.1
English 242 400 6.4
Part III 1998 2400 8.7
Part IV 613 800 7.7
Part V 74 100 7.4

27. Have You furnished the mark statement for six semesters?: Yes
I declare that the particulars furnished above are true and correct.
I submit that I will abide by the rules and regulations of the College.
Place:
Date :08/07/2021 Signature of the Student

FOR OFFICE USE ONLY


Received and Registered on :__________________________________________________________________

Interview Date :_______________________________ Fees Paid :_____________________________

Certificates Verified

 HSC MARKSHEETS  COMMUNITY CERTIFICATE

 TRANSFER CERTIFICATE  CONDUCT CERTIFICATE

 SPECIAL CATEGORY CERTIFICATE  ELIGIBLITY CERTIFICATE

Signature of the Staff who processed the Applicaiton:

NOT ADMITTED PROVISIONALLY ADMITTED ADMITTED

PRINCIPAL

You might also like