Telangana Residential Educational Institutions Society (Regd.

), Hyderabad
Application for TSRJC Common Entrance Test -2016

Personal Details
1
2
3
4
5
6
7
8

Reference Id :
Surname :
Candidate Name :
Father Name :
Mother Name :
Date of birth :
Gender :
Address :

9
10
11
12
13
14
15
16
17

e-Mail :
Mobile :
Reservation Category :
Medium of Study in Class X :
Category(General/Minority) :
Group/Course Opted :
Mention District by Study/Nativity :
Reservation under Sports :
Reservation under CAP(Childern of Armed
Personnel) :
18
Are you a Physically Handicapped(PH)
Person :
Qualification Details
19
Board :
20
SSC Hallticket Number :
21
Examination Center :
22.Payment Details
Fee Amount
150 /-

8600004371
Giddalapati
G LAXMIKANTH REDDY
G GOVERDHAN REDDY
G SUJATHA
17/1/2000
Male
1-42,
VENKAT REDDYPALLY
Mandal : Gandeed
District : Ranga Reddy
Pincode: 509337
laxmikanthreddy17@gmail.com
9912158638
OC
ENGLISH
General
MPC
Mahabubnagar
No
No
No

OTHER BOARD
400650024
Mahabubnagar

Journal Number

Payment Date

FHCC4396867597

04/04/2016

I hereby declare that

I read the information bulletin of TSRJC CET 2016 and found myself fully eligible to appear for the entrance test
as per the criteria mentioned in the bulletin.
I am appearing for Class X(2016) Public examinations as a fresh candidate(First attempt, not compartmental) and the
particulars furnished above are true to the best of my knowledge and belief.

Sd/G LAXMIKANTH REDDY

( 04-04-2016 01:27:39 PM )