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PERSONAL DETAILS

Name of Candidate
(in BLOCK LETTERS)



Date of Birth

Sex Male/Female
Father’s / Guardian’s
Name & Occupation


Permanent Address




Address for
Correspondence



Mobile No.

Phone (R)
Email







FOR OFFICE USE ONLY
Registration No.

Date of receipt.
Admission Granted YES / NO
Fees Receipt No.

Remark if Any

CENTRE FOR CONTINUING EDUCATION
GOVERNMENT ENGINEERING COLLEGE BARTON HILL
THIRUVANANTHAPURAM – 695035

Website : www.gecbh.ac.in Email: adamcourse@gecbh.ac.in
Phone : 0471 2300484, 2300485 Fax : 0471 - 2300484

ADVANCED DIPLOMA IN AUTOMOTIVE MECHATRONICS (ADAM)
Application form for Admission
Affix a Recent Photograph



QUALIFYING EXAM DETAILS
(Please enclose copy of final year mark list OR bona fide certificate if appeared / appearing for final year exams)
Examination Passed Board / University CGPA / Percentage of
Marks
Year












DETAILS OF WORK EXPERIENCE

Name and address of Organization Post Held Duration


DEMAND DRAFT DETAILS
Name of Bank

DD Number

Date

* Note: The downloaded and filled in application form along with a demand draft of Rs 500/-(non–refundable entrance examination fees) favoring
“Coordinator-ADAM, Government Engineering College, Barton Hill” should be sent to “Coordinator - ADAM, Government Engineering College, Barton
Hill, Thiruvananthapuram PIN – 695 035”. Forms received without the above Demand Draft will be rejected.
Declaration:
I hereby certify that the entries made by me in Application form are correct to the best of my knowledge and I
have not concealed any information in any manner.
I certify that I am not involved in any illegal activity and no criminal case is pending against me in any court of law.
I understand that if at any stage, it is found that I have provided any wrong information to seek admission to
the Institution, my admission shall stand cancelled automatically and I shall have no claim whatsoever, on the seat
or the dues paid to Institution.
I hereby declare that I have read and fully understood all the conditions above and freely agree to abide by them.





(Dated Signature of the Candidate)