GOVERNMENT OF KERALA

DEPARTMENT OF TECHNICAL EDUCATION

Application to Polytechnic College Admission 2017-18

Application No. : 194792 Page: 1 of 2

Fee to be remitted at
Date of online entry: 26-05-2017
Polytechnic College : Rs. 75/-

Basic Details
1. Name of the Candidate: SIBIN K 2. Name of Guardian KRISHNAN. K
3. Relationship with Applicant: Father 4. Communication Address: Sreekrishna(ho),chunnabukarankulambu,karimkayam(po),parassery,mangalam
dam ,pin:678706,palakkad (dt)
5. PINCODE: 678706 6. Mobile No.: 9400858367
7. E-mail Address: Sibin652@gmail.com 8. Aadhar: 9937 0625 8083
9. Gender: Male 10. Date of Birth: 09-03-2000
11. Nationality: Indian 12. Native District: Palakkad
13. Annual Income: 48000 14. Creamy Layer or Not: Not Applicable

Community and Other Reservation Details Qualifying Examination Mark/Grade Details

1. Are you eligible for No Sl. Subject Name Grade
reservation under Inter-caste No.
married ? 1 LANG I A
2. Community: Scheduled Caste 2 LANG II A+
3. Whether OEC: No 3 ENGLISH B+
4. ITI/KGCE : None 4 HINDI B
5. VHSE : None 5 SOCIAL B
6. Are you a person with No 6 PHYSICS B
disability ?
7 CHEMISTRY C
7. Special Reservations: Not Applicable
8 BIOLOGY B
Qualifying Examination Details 9 MATHS B
1. Examination: SSLC 2. No. of Subjects: 10 10 IT A+
3. Year of Passing: 2015 4. Register No.: 348130
5. No. of Chances 1
Taken:

Options
Opt. Polytechnic College Diploma Programme
No.
1 Government Polytechnic College, Palakkad Computer Hardware Engineering
2 St. Mary's Polytechnic College, Vadakkencherry Computer Engineering
3 IPT & GPTC, Shoranur Computer Engineering
4 Aries Polytechnic College, Attappady, Palakkad Electrical & Electronics Engineering
5 Government Polytechnic College, Chelakkara Computer Engineering
6 Maharaja's Technological Institute, Thrissur Computer Engineering
7 Government Polytechnic College, Koratty Instrumentation Engineering
8 Government Polytechnic College, Kunnamkulam Computer Engineering
9 Malabar Polytechnic Campus, Cherupulassery, Palakkad Electrical & Electronics Engineering
10 Aries Polytechnic College, Attappady, Palakkad Electronics Engineering
11 Sree Rama Government Polytechnic College, Thriprayar Computer Engineering
Application No. : 194792 Page: 2 of 2

Copies of Certificates Attached

1. SSLC/THSLC or equivalent Certificate
2. Community Certificate from concerened Tahsildar.
3. Income Certificate from Village Officer.

Declaration
1. I hereby declare that, I have read the various clauses in the Prospectus for Admission to Polytechnic Colleges 2017 - 2018 and the
instructions carefully and I agree to abide by them.
2. I also declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief
and that in the event of any information being found false or incorrect or ineligibility being detected before or after the admission,
action can be taken against me.

Signature of the Parent/Guardian Signature of the Applicant

Place
Date

Certified that all the details entered above are verified and found correct.

Name and Signature of Verifying Officer

ACKNOWLEDGEMENT

Received an application from SIBIN K S/D/W/o Sri./Smt. KRISHNAN. K for Polytechnic College Admission (Application No.

194792 ) on ....................... at ................................................................................ An amount of Rs. 75/- is received as the

application fee.

The Application is registered with Registration No.........................

for Principal

Seal of Receiving Polytechnic College

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