ENGINEERING & TECHNOLOGY

Application Number 3616627

Application Submitted on: 17-Feb-2013

ADMISSION 2013

1.SIGNATURE

2. NAME OF THE APPLICANT

R.RAHUL KRISHNA

3. GENDER 4. RELIGION 5.NATIONALITY

Hinduism Indian

Male Female

6.COMMUNITY 7. DATE OF BIRTH

01-Aug-1995
General/OC OBC/BC/MBC SC ST

8. MOTHER TONGUE 9.NATIVE STATE 10.NAME OF PARENT/GUARDIAN

SRM UNIVERSITY

Tamil 23 T.RAMASAMY
Tamil Nadu 35

11. ADDRESS FOR CORRESPONDANCE(DO NOT REPEAT NAME)

93/C,Jaswanth Nagar Extn.,

12. CITY Chennai

14.STATE
13. DISTRICT 15.PINCODE

Chennai Tamil Nadu 35 600037

16.STD CODE 17.TELEPHONE NUMBER 18.MOBILE NUMBER

9600160642

19. EMAIL ADDRESS

rahul.krishna95@yahoo.com

Application Printed Date: 17-Feb-2013 Page 1 of 2 [P.T.O]

 20.DETAILS Xth AND XIIth STANDARDS PASSED APPEARING
SCHOOL EXAM SCHOOL BOARD/ REGISTRATION MONTH/YEAR % OF MARKS
UNIVERSITY NUMBER

XII standard D.A.V. BOYS SENIOR SECONDARY Central Board of

SCHOOL , PLOT NO.R-45, 120 FEET
Secondary Education Not Required 01/03/2013 0
ROAD, MOGAPPAIR CHENNAI-600050.
14

X standard
Not Required Not required Not Required Not Required 81.70

21.DETAILS OF THE QUALIFYING EXAMINATION FOR UG/PG DIPLOMA PROGRAMS

ADMISSION 2013

PASSED APPEARING
QUALIFYING COLLEGE UNIVERSITY REGISTRATION MONTH/YEAR OF AGGREGATE
EXAM NUMBER PASSING % OF MARKS

22.PARENT'S OCCUPATION 23.PARENT'S INCOME (RS)

Business 60 2,00,001 - 4,00,000

24. PROGRAM APPLIED
GROUP-I GROUP-II GROUP-I GROUP-III
B.Tech M.Tech MBA B.Arch B.Des PGPM PGPRM M.ARCH B.B.A
SRM UNIVERSITY

24(a).OPTION FOR ONLINE EXAM 24(b).OPTION FOR PAPER/PENCIL EXAM

YES NO YES NO

25.CHOICE OF ONLINE EXAM SLOT(ONLY FOR GROUP I) 26.TEST CITY CENTRE

- N/A
27. BRANCH/SPECIALIZATION
1). 151-B.Arch.-Architecture

28.DECLARATION
I hereby declare that I have carefully read the instructions and particulars supplied to me that the entries made in this application form are correct to the best of my
knowledge and belief. I note that the decision of the University is final in regard to selection for admission. If selected for admission, I promise to abide by the rules
and regulations of the University and the guidelines in the prospectus. The University shall have the right to expel me from the University at any time after
admission, provided it is satisfied that I was admitted on false particulars furnished by me or my antecedents prove that my continuance in the University is not
desirable. I agree that all disputes are subject to the jurisdiction of the courts at Chennai only. Fees Paid on counselling and admission will not be claimed back
under any circumstances.

Payment TXN No: 201302178420566

Payment Status: Successful

SIGNATURE OF APPLICANT DATE: 17-Feb-2013

VALID FOR THE ACADEMIC YEAR 2013-2014 ONLY

Application Printed Date: 17-Feb-2013 Page 2 of 2