APPLICATION FOR REGISTRATION OF ARCHITECTS

UNDER THE ARCHITECTS ACT,1972

The Registrar Enrolment No. Application No.

Council of Achitecture COA-089281 116279
New Delhi

CANDIDATE NAME : Mr. S R SAIVAA MUTHAIYA

FATHER'S NAME : Shri. ROOP KUMAR

NATIONALITY : Indian

DATE OF BIRTH : 21/06/1996 EMAIL ID : shaivamuthaiya@yahoo.com

MOBILE NUMBER : 07259975877 GENDER : Male

RESIDENTIAL ADDRESS : ANNU VILLA ,168B , ULIYAKOVIL PROFESSIONAL ADDRESS : ANNU VILLA ,168B , ULIYAKOVIL
NAGAR, ULIYAKOVIL , KOLLAM- NAGAR, ULIYAKOVIL, KOLLAM-
691019, KERALA 691019, KERALA

Particulars of Qualification
Qualification From Indian Certificate Type Provisional

Visvesvaraya Technological University,

Course Name Bachelor of Architecture University Name
Belgaum

Year of Admission/
School of Architecture KA12-R.V. College of Architecture 2014/2019
Passing

Date of Commencement of
N/A Practicing With : N/A
Profession/ Service :

CORRESPONDENCE ADDRESS PERIOD OF RESIDENCE IN

23 Years 3 Months
: ANNU VILLA ,168B , ULIYAKOVIL INDIA :
NAGAR, ULIYAKOVIL, KOLLAM-
691019, KERALA PERIOD OF RESIDENCE
N/A
OUTSIDE INDIA :

Qualifying Examination (10+2 or Equivalent)

Name Of Examination 10+2 or Equivalent Name Of Board Central Board Of Secondary Education

Mathematics Passed Yes Category OBC

Aggregate Marks 461/500 Percentage 92%

I hereby undertake that if admitted as a Registered Architect, I shall be bound by the provisions of the Architects Act, 1972 and the
Rules and Regulations framed thereunder or that may hereafter from time to time be made pursuant to the said Act.
I also enclose cash/demand draft of Rs 600/- in favour of "COUNCIL OF ARCHITECTURE", payable at New Delhi, as registration fee
(Non-refundable).

Yours faithfully

Date: 21-September-2019 (Signature of Applicant)

For Office Use

Receipt Date: Receipt No:

Registration No.: Date of Registration:

(Registrar)