APPLICATION FORM FOR ADMISSION TO

SECOND YEAR B.E/B.TECH. DEGREE COURSES 2018-2019.

Application No. : 8300137
1. Group Name: : ELECTRICAL
2. Branch Name of the Qualifying Diploma/B.Sc. Degree Course : COMPUTER SCIENCE AND ENGINEERING
3.Differently Abled (Certificate should be enclosed) : NO
4. Eminent Sports Person : NO
5. Children of Freedom Fighters : NO
6. Children of Ex-Servicemen : NO
7. Name of the Candidate : V.SASIKUMAR
8. Name of the Parent/Guardian : S.VISWANATHAN
9. Permanent Address (with Pincode No.) : 60 B, V.G.P.LAYOUT, 1ST PART,
2ND MAIN ROAD,
PALAVAKKAM, CHENNAI.
Pincode :600041
10.Address for Communication (with Pincode No.) : 60 B, V.G.P.LAYOUT, 1ST PART,
2ND MAIN ROAD,
PALAVAKKAM, CHENNAI.
Pincode :600041
11.Email Id : smartsasi1111@gmail.com
12.Contact Number. : 7010715261
13.Aadhaar No. : 730789734440
14.Sex : MALE
15.Date of Birth : 25/02/1999
16.Citizenship : INDIAN
17.Nativity : TAMIL NADU
18.Srilankan Tamil Refugee : NO
19.Community : BC(Backward Class)
20.Name of Sub Caste : VANIA CHETTIAR
21.Diploma/B.Sc. Examination Register No. : 15503272
22.Details of Institution Last Studied:
Discipline of the Qualifying
Name of the Polytechnic/College and Address. Board/University
Diploma/Degree
PSB POLYTECHNIC COLLEGE TNDTE

23.Diploma/B.Sc. for : Regular

24.Marks Obtained in Diploma/B.Sc. Qualifying Examination:
Semester Month & Year of Passing Marks Obtained Maximum Marks
1st Semester 10/2014 457 800
2nd Semester 04/2015 524 900
3rd Semester 10/2015 423 700
4th Semester 04/2016 453 700
5th Semester 10/2016 470 700
6th Semester 04/2017 566 700

TOTAL 2893 4500

25.Overall % of Marks in the Qualifying Examination : 68

26.Where Mathematics is studied as one of the subjects in +2/Degree Level(for B.Sc. Candidates Only) :
27.Details of Application Registration Fees Paid:
Demand Draft No. DD Amount(Rs.) DD Date Name of the Bank, Branch
211611 300 19/05/2018 INDIAN BANK, ADYAR
 Application No. : 8300137
DECLARATION BY THE APPLICANT
I, V.SASIKUMAR Son/Daughter of S.VISWANATHAN hereby solemnly declare that the information
furnished and the statements given in the application, coding sheet and the enclosure are true, correct and
complete. I further declare that should it be found otherwise, I will be liabl to forfeit my seat and/or
remove from the rolls of the Institution at whatever stage of study I may be, besides making me liable for
criminal prosecution. I am fully aware that as per the directions of the Hon'ble Supreme Court of India and
Tamil Nadu Prohibition of Ragging Act 1997 is an offence, as is banned in the Institutions and anyone
indulging in ragging is liable to be punished such as expulsion from the Institution and / or rigorous
imprisonment upto 3 years, and /or fine upto Rs.25,000/-.

Place:

Date: (Signature of the Applicant)

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DECLARATION BY THE PARENT / GUARDIAN
I, S.VISWANATHAN Parent/Guardian of V.SASIKUMAR hereby solemnly declare that I am fully
aware of the declaration made by the applicant, my Son/Daughter/Ward and I declare and bind myself on
the same terms contained in the above declaration. The statements and the information given are true,
correct and complete. If it is found otherwise, the applicant is liable to forfeit the seat and / or removal
from the rolls of the Institution and whatever may be the stage of study, besides making me liable for
criminal prosecution. I am fully aware that as per the directions of the Hon'ble Supreme Court of India
and Tamil Nadu Prohibition of Ragging Act 1997, Ragging is an offence, as is banned in the Institutions
and any one indulging in ragging is liable to be punished such as expulsion from the Institution and / or
rigorous imprisonment upto 3 years, and / or fine upto Rs.25,000/-.

Place:

Date: (Signature of the Parent/Guardian)

Note: Guardian can execute the above declaration, only if both parents are not alive.
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CHECK LIST
(To be ticked by the Candidate)
1. Self Attested Photocopy of All Semester Mark Sheets(All appearances) of Diploma/B.Sc.
or Equivalant Examinations (Xeroxing both sides).
2. Self Attested Photocopy of Diploma/Degree of Provisional Certificate.
3. Self Attested Photocopy of Transfer Certificate.
4. Self Attested Photocopy of Permanent Community Certificate Card for ST, SC, SCA,
MBC & DNC, BC, BCM.
5. Self Attested Photocopy of Nativity Certificate(if applicable).
6. Self Attested Photocopy of First Graduate Certificate and First Graduate Joint Declaration
(if applicable).
7. Plus Two Mark Sheet(for B.Sc./Lateral Entry Diploma Candidates).
8. Special Reservation Form(s)(if applicable).

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 Direct Second Year B.E. / B.Tech. Degree Admissions 2018, Alagappa
Chettiar College of Engineering and Technology,Karaikudi 630 003,before the last date specified. Use only in the A4 size cover
duly affixing the downloaded address label
 DEPARTMENT OF TECHNICAL EDUCATION:TAMIL NADU

Admission to Second Year B.E/B.Tech. Degree Courses - 2018-2019

GroupName. : COMPUTER SCIENCE AND ENGINEERING

Community. : BC(Backward Class) Application No: 8300137

Special Quota. :

To
The Secretary
Second Year B.E./B.Tech. Degree Admissions - 2018
Alagappa Chettiar Government College of Engineering and Technology
Karaikudi - 630 003.

From
V.SASIKUMAR
60 B, V.G.P.LAYOUT, 1ST PART,
2ND MAIN ROAD,
PALAVAKKAM, CHENNAI.
Pincode : 600041