ANNAMALAI UNIVERSITY LAST DATE

FORM OF APPLICATION FOR REGISTRATION (i) WITHOUT FINE (POSTAL / ONLINE) : 15.04.2019
(iI) WITH FINE OF `500 (POSTAL / ONLINE)
DEGREE/DIPLOMA/CERTIFICATE/FOUNDATION/GRADE EXAMINATIONS MAY 2019 : 22.04.2019
(FOR STUDENTS OF DISTANCE EDUCATION) (iii) WITH FINE OF `750 AT ANNAMALAI NAGAR
EXAM CENTER ONLY (ONLINE) : 30.04.2019
[ALL ENTRIES SHOULD BE IN CAPITAL LETTERS]

_____________________________________________________________________________________________________________________

I. COURSE : DIPLOMA IN INDUSTRIAL SAFETY Affix recent

passport size
photo attested
II. COURSE CODE : 0 5 1 by self

III. ENROLMENT NUMBER : 0 5 1 1 8 0 1 6 2 7

1.EXAMINATION CENTRE CODE: 0 0 9 CENTRE NAME: DHARMAPURI

(REFER TO THE CENTRE CODE LIST ATTACHED)

2.CANDIDATE NAME: V E D I Y A P P A N K

3.ADDRESS: 1/167B, MANJANAYAKANAHALLI(VILL&PO)

PENNAGARAM (TK)
DHARMAPURI(DT) PIN: 6 3 6 8 1 3
4. SUBJECT CODES OF (THEORY ,PRACTIAL & PROJECT) PAPERS FOR WHICH APPEARING NOW:

I II III IV V VI VII VIII

I-SEM/YEAR 5 1 0 5 2 0 5 3 0 5 4 0 5 5 0
IX X XI XII XIII XIV XV XVI

II-SEM/YEAR

III-SEM/YEAR

IV-SEMESTER

V-SEMESTER

VI-SEMESTER

5. REG.NO. OF LAST APPEARANCE IF ANY:

6. EXAMINATION FEES PAID – BANK DETAILS: (ENCLOSE ORGINAL D.D. / CHALLAN)

(A) DD DETAILS:

NAME OF BANK : DD NO:

BRANCH CODE : AMOUNT:

D.D. DATE : _ / _ / 20_

(B) ONLINE PAYMENT TRANSACTION ID: 19041048212126 AMOUNT: 2 7 9 0

DATE : 11 _ / 20_19
_ / 04
7. HAVE YOU REMITTED THE TUTION FEES UP-TO-DATE. YES NO
8. HAVE YOU ATTENDED THE COMPULSORY PERSONAL CONTACT PROGRAMME. YES NO

DATE : 12/04/2019 SIGNATURE OF THE CANDIDATE

NOTE: PLEASE RETAIN A COPY OF THE APPLICATION AND THE DD/CHALLAN FOR FURTHER CORRESPONDENCE
HALL TICKET CAN BE DOWNLOADED FROM THE WEBSITE FROM 10.05.2019 ONWARDS
 Date:11/04/2019

Course : 051-DIPLOMA IN INDUSTRIAL SAFETY

Center : 009-DHARMAPURI

Rollno : 0511801627 Name : VEDIYAPPAN K

email : vediappan97@gmail.com Mob: 8940250323

Fees Paid Details:

Payment Mode: Online Ref.No: 19041048212126 Gateway: ICICI BANK

Total Fees Rs. 2790 Tnx Date: 10-04-2019 12:54:24

Subject Codes:

510 520 530 540 550

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