App Form No 22B221366 Course Reg No 22BBCO156204
Mobile No 7604884726 CutOff out of 400 289.33
D. Roll No P. Roll No
(For Office Use Only)
(Autonomous)
Civil Aerodrome Post, Coimbatore, TamilNadu - 641014
Phone: 0422-4303300 E-mail: admission2022@[Link] Web: [Link]
Application form for admission to B.A. / [Link]. / B. Com. / BBA / BCA / [Link] / [Link]. Software System Courses
(Self Financing Courses)
Course [Link]
10th Register 20135011
Number
Full Name SURYA J
Gender MALE DOB (DD/MM/YYYY) 18/05/2004
Aadhar No 714113003925
Community Certificate
Community BC-OTHERS Sub Caste Name Kongu Vellalars
Issued by Tamil Nadu Government Issuing Authority ZONAL DEPUTY TAHSILDAR
Issued Place SULUR Issued Date 02/02/2008
Number 6657585 Religion HINDUISM
Contact Information
Father's Name JAYAKUMAR G Father's Mobile No 98422 40568
Father's BUSINESS Father's Annual Income 1000000
Occupation
Mother's Name POONGODI J Mother's Mobile No 98422 29989
Mother's OTHERS Mother's Annual 300000
Occupation Income
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Address M189 sihs colony
Name of City (or) COIMBATORE Nativity Urban
Village
District COIMBATORE State TN
Country INDIA Pincode 641014
Mobile 7604884726
E-mail suryajps52@[Link]
Special Categories
Are you a Sportsperson? NO
Are you a NCC cadet? NO
Are you a ward/wife/widow of an Ex-Service person? NO
Are you Differently Abled / Physically Challenged? NO
Academic Information
Board CBSE Year of first appearance for 2021
12th Exam
Nature of Course ACADEMIC First Graduate Yes
Month / Year of
Subject Marks Secured Marks Out Of Register No No. of Attempts
Passing
NA
ENGLISH 72 100 05/2022 20661144 1
Part - III Subjects
ACCOUNTANCY 72 100 05/2022 20661144 1
BUSINESS STUDIES 78 100 05/2022 20661144 1
ECONOMICS 67 100 05/2022 20661144 1
NA
Total 433.33 600 Part III Total marks out of 400 289.33
Percentage 72.22 100 400
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12th/Diploma Register Number 20661144
Name Address of the School Name NATIONAL MODEL SENIOR SECONDARY SCHOOL CBSE
School last Studied
District COIMBATORE
Place PEELAMEDU
DECLARATION
I declare that all the particulars furnished above are true and correct. I submit that I will abide by the rules and regulations of
the college if admitted.
Note - Attested copies of Mark Sheet and Community Certificate only to be enclosed with the application
Place: Coimbatore
Date: 22/07/2022 02:44 PM
Signature of the Parent / Guardian Signature of the Applicant
FOR OFFICE USE ONLY
Data Entered by Data Verified by
Certificate Verified
10th Marksheet Transfer Certificate Equivalence Certificate
11th Marksheet Community Certificate Special Category
Certificate
12th Marksheet Migration Certificate Name & Signature of staff who Signature of Principal
processed this Application
Certificates Verified by Admission Date
***** Please do not send the application via post *****
Printed on 22/07/2022 [Link] pm
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