APPLICATION FORM FOR ADMISSION TO MBA COURSE 2019-2020

Application Number:100001

1.TANCET 2019 Registration

12345678
Number :

2.Name : VIMALKUMAR

3.Name of Parent/Guardian : SELVARAJ

Affix your passport size photo

4.Address for Communication : X CROSS STREET, CHENNAI 600018.

5.Email Id : •••••••••••••••••••••

6.Contact Telephone Number : --

7.Mobile Number : ••••••••••

8.Sex : Male

9.Citizenship : INDIAN

10.Nativity : TAMIL NADU

11.Srilankan Tamil Refugee : NO

12.Place of Birth : CHENNAI

13.Mother Tongue : TAMIL

14.Date of Birth : 27-04-1988

15.Name of the Community : •••••••

16.Caste Code : 143

17.Religion : •••••

18.Name of the Caste : •••••••••••••••••••••••••••••

19.Differently abled Quota? : No

20.Qualifying Degree : B.E. / B.TECH

21.Pattern of Study (in years) : (10+2+4)

22.Appearance in Final Year PASSED (April 2009)

Exam? :

23.TANCET Marks in 2019 : 45

24.School/College study information

Class/Degree Year of Passing Name of the School/College District State

XI 2004 DBTR National HSS Nagapattinam TAMILNADU

XII/Diploma 2005 DBTR National HSS Nagapattinam TAMILNADU

Degree 2009 Government College of Technology Coimbatore TAMILNADU

25.Details of Marks in UG Degree qualifying examinations
a).UG degree : B.E CSE
b).Name of the College with Address : Govt College of Technology, Thadagam Road, Coimbatore -13
c).Name of the University : ANNA UNIVERSITY

Semester/Year Month and Year of Passing Maximum Marks Marks Obtained

I 12/2005 600 500

II 04/2006 600 500

III 12/2006 600 500

IV 04/2007 600 520

V 12/2007 600 550

VI 04/2008 600 500

VII 12/2008 600 510

VIII 04/2009 600 500

Overall Total 4800 4080

Total % of Marks 85

26.Average Percentage of Marks upto Pre-final Semester/Year

Total Maximum Marks Total Marks Obtained Percentage of Marks

4200 3580 85.23

27.Demand Draft details

DD Number DD Amount (Rs) DD Date Bank Name and Branch

123654 300 15-07-2019 SBI, GCT Branch , Coimbatore

 DECLARATION BY THE APPLICANT

All the information furnished prepage are true to the best of my knowledge. I am aware that any wrong information or suppression of
information may result in punitive action in addition to the summary cancellation of my candidature for admission and forfeiture of the fee
paid.

I have the required qualification for admission to MBA/MCA Degree Programme as prescribed.
I have studied Bachelor's Degree course in 10+2+3/4/5 years pattern (or) 10 + 3 years Diploma + 3 years pattern.
I have not studied B.E. / B.Tech Degree through distance / week end mode.

I am also aware that a pass in recognized bachelor's degree of minimum 3 years duration in 10+2+3/4/5 years pattern and obtained at
least 50% (45% in case of candidates belonging to reserved category) at the qualifying examination is the minimum eligibility required for
admission to PG courses as per AICTE norms.

Place:
Date: Signature of the Applicant

CHECKLIST
(To be filled by Applicant)

Tick Tick
( ) ( )
1.Self Attested Photograph affixing on the 7.Self Attested Photocopy of TANCET 2019 Hall
Application. Ticket.
2.Self Attested Photocopy of Plus Two Mark Sheet 8.Self Attested Photocopy of TANCET 2019 Mark
/ Diploma Certificate. Sheet.
3.Self Attested Photocopy of All Semester Mark
9.Self Attested Photocopy of Nativity Certificate (if
Sheets (All appearances) of qualifying
applicable).
Examination (Xeroxing both sides).
4.Self Attested Photocopy of Degree or Provisional 10.District Medical Board Certificate (for Differently
Certificate. Abled Persons only).

5.Self Attested Photocopy of Transfer Certificate. 11.Sri Lankan Tamil Refugee certificate -If applicable

6.Self Attested Photocopy of Permanent Community

12.Included Original Demand Draft (DD)
Card for ST, SC, SCA, MBC & DNC, BC, BCM.

Note

After submitting online, printout of the application, relevant enclosures and the original Demand Draft(DD) must be sent by post or
dropped in a box at the office of the "The Secretary, TN MBA / MCA Admissions - 2019, Government College of Technology,
Coimbatore 641 013" before 03-08-2019. Use only in the A4 size cover duly affixing the downloaded address label.

FOR OFFICE USE ONLY

The Candidate is Eligible / Not Eligible
( If Not Eligible Specify the Reason)

Scrutinizing Staff Name

Signature