GOVERNMENT OF KERALA

DEPARTMENT OF TECHNICAL EDUCATION

Application to Polytechnic College Admission 2015-16
Application No.:
Date of online entry:

100030

Page :

10/05/2015

Fee to be remitted: Rs. 100/- x 1 = Rs. 100/-

1 of 3

Admission Sought for : 1) Palakkad

1. Name of the Candidate:
2. Communication Address:

MOHAMMED NAVAS F
16/20,najma,krishna nagar
ummni,dhoni

PIN CODE:

678009

5. Mobile No.:

9745033978

4. E-mail:

n7a8v6a7s@gmail.com

5. Gender:

Male

6. Date of Birth:

07/08/1996

7.Nationality:

Indian

8. Native District:

Palakkad

9.Annual Family Income:

582720

10.AADHAR:

932944981591

1.Community

Muslim

2.Whether OEC:

No

Special Reservations:

No

Passed SSLC in 2013 with Reg No 367761 in chance 1

Sl. No.

Subject Name

Grade

1
2
3
4
5
6
7
8
9
10

LANG I
LANG II
ENGLISH
HINDI
SOCIAL
PHYSICS
CHEMISTRY
BIOLOGY
MATHS
IT

B
B
A+
B+
B
A
B+
A+
C
A+

Sr. No

Poly Name

Course Name

District:
1
2
3
4
5
6
7
8
9
10
11
12
13
14

Palakkad
Government Polytechnic College, Palakkad
Government Polytechnic College, Palakkad
Government Polytechnic College, Palakkad
Government Polytechnic College, Palakkad
Government Polytechnic College, Palakkad
Government Polytechnic College, Palakkad
St. Mary's Polytechnic College, Vadakkencherry
St. Mary's Polytechnic College, Vadakkencherry
St. Mary's Polytechnic College, Vadakkencherry
St. Mary's Polytechnic College, Vadakkencherry
St. Mary's Polytechnic College, Vadakkencherry
Malabar Polytechnic Campus, Cherupulassery, Palakkad
Malabar Polytechnic Campus, Cherupulassery, Palakkad
Malabar Polytechnic Campus, Cherupulassery, Palakkad

Civil Engineering
Computer Hardware Maintenance
Electrical & Electronics Engineering
Electronics Engineering
Instrument Technology
Mechanical Engineering
Automobile Engineering
Civil Engineering
Computer Engineering
Electrical & Electronics Engineering
Mechanical Engineering
Civil Engineering
Electrical & Electronics Engineering
Mechanical Engineering

Application No.:
100030
15
Aries Polytechnic College, Attappady, Palakkad
16
Aries Polytechnic College, Attappady, Palakkad
17
Aries Polytechnic College, Attappady, Palakkad
18
Aries Polytechnic College, Attappady, Palakkad
19
Aries Polytechnic College, Attappady, Palakkad

Page :

2 of 3
Automobile Engineering
Civil Engineering
Electrical & Electronics Engineering
Electronics Engineering
Mechanical Engineering

Certificate Details
Sl No. Name of Certificate

Cert.No.

Issue Date

Authority

1
2
3

070195
9858555
9817755

24-04-2013
16-1-2015
14-01-2015

board of public examination kerala

village office akathethara
village office akathethara

SSLC/THSLC or equivalent Certificate

Community Certificate from Village Officer.
Income Certificate from Village Officer.

Declaration
1. I hereby declare that, I have read the various clauses in the Prospectus for Admission to Polytechnic Colleges 2015 - 2016
and the instructions carefully and I agree to abide by them.
2. I also declare that all the statements made in this application are true, complete and correct to the best of my knowledge
and belief and that in the event of any information being found false or incorrect or ineligibility being detected before or
after the admission, action can be taken against me.

Signature of the Parent/Guardian

Place:
Date:

Signature of the Applicant

Application No.:

100030

Page :

3 of 3

Receipt

Received from MOHAMMED NAVAS F, S/D/W/o Sri. B MOHAMED FAROOK ,

application for Polytechnic Admission (Application No. 100030) on ........................ at ...............................................................
Polytechnic College,............................................. an amount of Rs. Rs. 100/- x 1 = Rs. 100/- is received as the application fee.
The Application is registered with Registration No................
Polytechnic College Admission Website: www.polyadmission.org

Seal of Receiving Polytechnic College

Principal

Receipt

Received from MOHAMMED NAVAS F, S/D/W/o Sri. B MOHAMED FAROOK ,

application for Polytechnic Admission (Application No. 100030) on ........................ at ...............................................................
Polytechnic College,............................................. an amount of Rs. Rs. 100/- x 1 = Rs. 100/- is received as the application fee.
The Application is registered with Registration No................
Polytechnic College Admission Website: www.polyadmission.org

Seal of Receiving Polytechnic College

Principal