Last Date: 21.03.

2020 Registration No : SP 16 CEU 330

St. PETER’S INSTITUTE OF HIGHER EDUCATION AND RESEARCH

(Deemed to be University U/S 3 of the UGC Act, 1956)
Avadi, Chennai – 600 054.

END ASSESSMENT, APRIL /MAY – 2020

B.E. / B.Tech.
(On -Campus Programme)
(2016-17 Batch)

EXAMINATION APPLICATION FORM

Branch: B.E. CIVIL ENGINEERING

1. Name in BLOCK LETTERS : ARUNKUMAR R

(as in the 10th certificate in English)

2. Gender : Male

3. Date of Birth : 12-11-1995

4. Nationality : INDIAN

5. Social Status and Community : SC- HINDU

6. Father’s Name : B RAJENDRAN

7. Mother’s Name : R VASANTHI

8. Blood Group : A1+

9. Aadhaar Number : 304562853811

10. (a) Present Address with pin code : NO 57 RUKUMANI NAGAR ADYAR ,
CHENNAI
(in BLOCK LETTERS) PINCODE : 600020

(b) Permanent Address with pin code : NO 57 RUKUMANI NAGAR ADYAR,

CHENNAI
(in BLOCK LETTERS ) PINCODE: 600020

(c) Mobile Number : 8072146667

P.T.O
 11. Particulars of Educational qualification:

Qualifications Board/College/ Month and year Reg. No. Average marks /Class
University of passing

Note: Copies of the certificates and Transfer Certificate are to be enclosed.

No. of Papers
Semester Theory Practical
12. (a) No. of papers in the End Assessment :
Arrear papers in VIII Semester
Arrear papers in VII Semester
Arrear papers in VI Semester 5
Arrear papers in V Semester
Arrear papers in IV Semester 5
Arrear papers in III Semester 1
Arrear papers in II Semester 3
Arrear papers in I Semester

Amount
(b) Total amount of End Assessment Fee : (Rs.)
VIII Semester (Arrear)*
VII Semester (Arrear)*
VI Semester (Arrear)* 2500
V Semester (Arrear)*
IV Semester (Arrear)* 2500
III Semester (Arrear)* 500
II Semester (Arrear)* 1500
I Semester (Arrear)*
Total 7000

(c) Date of Payment of Arrear Examination Fee: NOT PAID

(Enclose a copy of the challan)

13. Whether Transfer Certificate is received. : Yes / No
(If yes, enclose a copy)

I certify that all the above particulars given by me are correct.

Date: Signature of the Student

* Arrear Examination Fee Structure Theory : Rs.

500 per paper Practical :
* Rs. 250 per practical

SIGNATURE OF HOD (With Seal)

Note: The filled-in application is to be submitted to the Controller of Examination through the HOD concerned.