VELS SRINIVASA COLLEGE

OF ENGINEERING AND TECHNOLOGY

THALAMBUR, CHENNAI-603103

REGISTRATION FORM
REGISTER NUMBER
3 1 6 0 6 1 0 6 0 4 5 Affix your latest passport size photo here

PERSONAL DETAILS
1. NAME (IN BLOCK LETTERS) G M . A M L O I H M D A R Y U S U F S A H I B

2.

DEPARTMENT

E M

L M

E U

C N

T I

R C

O A

N T

I I

C O

S N

3. BATCH

4.

FATHERS NAME

5. MOTHERS NAME

6. DATE OF BIRTH

7. MARITAL STATUS

Y SINGLE M MARRIED (TICK IN RESPECTIVE BOX)

8. GENDER (M/F) 6

9. PERMENANT ADDRESS

/ N

A A A G P

PE E O A R T

R E T

T N A

2 10. ADDRESS FOR COMMUNICATI ON M T

/ S T

6 O H

1 U I T R

K H U

M M

A A N

C D M

H A I

I S Y U

I T R

L R

L E

A E

11. PHONE (WITH CODE) NUMBER 9 8 4 2 1 6 5 7 7 3

12. MOBILE NUMBER

13. EMAIL ID

14. BLOOD GROUP

+VE

15. PASS PERCENTAGE

EMPLOYMENT DETAILS

JOB DESCRIPTION SOFTWAREENGINEER

ORGANIZATION NAME POLARIS

WORKING DURATION

SALARY (PER ANNUM) 2.2L

DATE: 12/03/2011 PLACE: Chennai g.yusuf APPLICANTS SIGNATURE