2017­5­21 KMAT ­ KERALA

KMAT KERALA ­ 2017
SUPERVISED BY ADMISSION SUPERVISORY COMMITTEE & FEE REGULATORY COMMITTEE FOR
PROFESSIONAL COLLEGES OF KERALA, EXAM CONDUCTED BY UNIVERSITY OF KERALA. 
COMPLETED APPLICATION FORM (for JUNE 2017)

PERSONAL DETAILS

  Application   SB Collect Reference
902055 DU66516209
No Number

  Name of Applicant Christopher C Dcruz

  Date of Birth 17/09/1994 , Age: 23

  Gender Male

  Nationality Indian

  Mettilda Cottage, Thanal Nagar, Kerelapuram, Perumpuzha, Kollam, Kerala,
  Address
691504

Land Phone Nil Mobile +919633452554

  Father's/Guardian's
Email christophercdcruz007@gmail.com   Cleetus J Dicruz
Name

RESERVATION DETAILS

  Religion Christian   Category SEBC

Caste Latin Catholic    

 QUALIFYING DEGREE DETAILS

  University of Qualifying Degree   Kerala University

  Degree Status   Graduation Completed

  Graduation   BCA

OPTED EXAM CENTRES FOR ENTRANCE TEST

SL. No. Centre

1  Kollam

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2017­5­21 KMAT ­ KERALA

2  Thiruvananthapuram

3  Pathanamthitta

DECLARATION

I hereby confirm that all the information given in the application are true to the best of my
knowledge. I also understand that if any of these details is found to be incorrect at any later stage,
then my KMAT application shall be deemed rejected.

Signature
Generated Date : 28/05/2017 11:20:32 am

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