Application No.

R. No. : HDDPP - F.87/96

: 890/05

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An ISO 9001 : 2008 CERTIFIED TRAINING CENTER
# 108-A, Sholinghur Road, (Near Post Office)
PALLIPAT - 631 207. Tiruvallur District.

Regd. No. :
(For Office Use)

ROLL No.:
N.B. : (a)
(b)

Application should be filed in English only with his/her own handwriting.

Without course fee the application will be rejected.

1.

Name of the applicant (In BLOCK Letters) :

2.

Father / Husband's name

3.

Date of Birth

4.

Educational Qualification

5.

Course Joining (Please Tick)

6.

Sex

7.

Nearest Govt. Examination Centre

8.

Admission Fee (Money Order or D.D.)

Lower Grade
Higher Grade

Full Address with Pin Code

Agriculture
Drawing
Tailoring

Male / Female

Rs.
M.O./D.D. No.:

9.

Ph

APPLICATION FOR ADDMISSION

oto

Distance Education

Date:

Pin :
Phone No. :

DECLARATION
I, .............................................................. hereby declare that the above given particulars about
myself are true to the best of my knowledge and I agree that if any wrong information found against of this
particulars I will obey to the management and its legal activities. Also I know well that in case of my
discontinuation of this course I will not be issued any refund of course fee.
Place :
Date :

Signature of the Apllicant

GOVERNMENT TECHNICAL EXAMINATION

ANNEXURE
Section I

Sub Code :

FOR OFFICE USE

District No.

Center No.

Register Number

Section II
TO BE FILLED BY THE CANDIDATE
Name

Sex (

L ) any one)
M

Clasification (Write any one : OC : OB : MB : SC : ST : BC)

Date of birth ( for example 1st July 1985 should be entered as

D

0 1 0 7 8 5

Section III
Subject (

L ) any one)

Grade

Medium Answering

AGRICULTURE
DRAWING
TAILORING
Note : The candidate should write all the particulars correctly both in the annexure and application.
There should be no discrepancy in furnishing the details which will otherwise entail rejection of the
application. The candidate should mention the subject and grade correctly.
Place :
Date :

Signature of the candidate

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STD : 044 Phone : 27843005

Cell : 9787948675 / 9787618675
Web: www.tnagrotrainingcenter.com
www.tnagtc.com

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