Application No(As per Allotment order)




Admission No(As per Allotment order)




Name of the Student(As per 10th Mark Sheet)




Name of the Father




Occupation




Annual Income




Name of the Mother




Address for Communication with(Pin code)




Select Gender: Male Female Other


Date of Birth(As per 10th Mark Sheet)




Nationality




Religion




Community:

Select Community General OC (Other Backward Class) BC (Backward Class) BCM (Backward Class Muslim) MBC (Most Backward Class) SC (Scheduled Caste) SCA (Scheduled Caste Arunthathiyar) SCC (Scheduled Caste Chakkiliyar) ST (Scheduled Tribe)

Name of the Caste (As per Community Certificate)




Native District




Community Certificate Particulars:

i. Issuing Office




ii. Issuing Officer (Designation) [Follow this format]




Name of the Institution last Studied




Medium of Institution


Board of Examination


TC number


TC Date