Online Application Form for Entrance Examination Preliminary Coaching Programme (December 2019 -

May 2020)
Examination Details
Coaching Preference :Non Application
Examination Centre : MADURAI Residential - Part Time (Only Registration No :
Classes without hostel facility) 16638
Personal Information

Applicant Name : MOHAMED AASICK Aadhaar Number : 308985524192

Gender:
Father’s Name (or) Guardian: ABDUL KAREEM Date of Birth : 29-05-1990 Age: 30
MALE
Native state : TAMILNADU Religion : MUSLIM community : BCM Caste : LABBAI

Special Category
Are you Differently Abled (DA)?: NO if Differently Abled, do you need scribe?: NO
Academic Information
SSLC Passing year : 2005 Board : TN STATE BOARD
+2Passing year: 2007 Board : TN STATE BOARD
UG UG Year
UG Degree & UG College / University:
Medium of of
Specialization : BSC MSS WAQF BOARD UG Percentage of Mark: 56
Study: Passing:
COMPUTER SCIENCE COLLEGE
ENGLISH 2010
PG Degree & PG College / University: PG PG Year
Specialization : MBA SYED AMMAL Medium of of
PG Percentage of Mark: 72
HUMAN RESOURCE AND ENGINEERING Study: Passing:
MARKETING COLLEGE ENGLISH 2012
 

Online Application Form for Entrance Examination Preliminary Coaching Programme (December 2019 -
May 2020)
Communication Information
Address for Communication : Permanent Address :
Door No : 7/262 Door No : 7/262
Street : PERIYAR STREET Street : PERIYAR STREET
City : RAMANATHAPURAM City : RAMANATHAPURAM
State : TAMIL NADU State : TAMIL NADU
Pincode: 623504 Pincode: 623504
LandLine : LandLine : TAMIL NADU
Have you already Undergone Preliminary Coaching at AICSCC? NO

Candidate Contact Number

Primary Contact Number : Secondary Contact Number : Email Address :
9566887182 9500782122 yasicks90@gmail.com
Terms and Conditions

1. I hereby declare that all the particulars furnished in the application are true, correct and complete to the best of my knowledge and belief
2. I am aware that in the event of any information being found false or incorrect, AICSCC is at liberty to disqualify my candidature at any stage
and also cancel my selection, if made.
3. I hereby declare that I will not be a party to any kind of canvassing on by behalf.
4. I hereby declare that I have not applied through any other mode.
5. I will produce the necessary certificates, documentary Proof related to the entrance Examination Process at the time of certificate
Verification, if called for and upon selection or thereafter.
6.I have verified the correctness of the particulars furnished in the application and take acknowledgement of the application.

Signature of the Candidate