Application Form

Manidha Naeyam IAS & IPS Free Coaching Centre

# 28, First Main Road, C.I.T Nagar, Chennai- 600 035. Ph: 044-2435 8373.

Application No: _______

Application for admission to the Photo

Coaching Classes for TNPSC
Group 1 (I) Examinations - 2008.

USE CAPITAL LETTERS

1. Name :
2. Sex : Male Female
3. a. Date of Birth :
st
b. Age as on 1 August 2009 :
4. a. Father’/Guardian’s Name :
b. Occupation :
c. Annual Income :
5. Whether SC/ST/OBC/OC :
6. Caste :
7. Nationality :
8. Are you employed? If so, furnish
the particulars of employment in detail. :
9. Religion :
10. Native: PLACE/DISTRICT :
11. Address for Communication (Present) : ...........................................................................
..........................................................................
..........................................................................
..........................................................................
12. Address for Communication (Permanent) : ...........................................................................
..........................................................................
..........................................................................
..........................................................................
13. Phone No / Mobile No :
 14. e-mail address (if any) :
15. Proposed Optional Subject(s) :
16. Indicate earlier appearances(year) if any :
a. Preliminary :
b. Main :
17. Educational Qualification :

No. Pre-Degree Name of the School/ Year of % of marks

College/ University Passing obtained
SSLC
Plus 2
BA/BSc/BBA/B.Com/
BBM/BCA
BE/BVSc/BEd/BL/MBBS
MA/MSc/M.Com/MCA/MBA
MPhil/Ph.D

Note: Xerox copies of 10th mark sheet, Community. Degree certificates should be enclosed.

I hereby declare that all statements made in the Application are true, complete and correct to
the best of my knowledge and belief.

Signature of the Father/Guardian. Signature of the Applicant.

Place:
Date:

CERTIFICATE
 On the basis of personal satisfaction documentary evidence produced before me,
I certify that Thiru/Thirumathi/Selvan/Selvi………………………………. is a graduate of the
University of …………………………….. holding …………………….. degree.

Place:
Date: Signature
Name in Capital letter with Office Seal.

 This certificate should be obtained from any gazetted officer or principal of any College.