Application for Admission to B.E / B.Tech / M.E. Sl. No.

COLLEGE OF ENGINEERING & TECHNOLOGY

Salem Main Road, NH 47 Pallakkapalayam,
Affix r ecent
Komarapalayam-637303, Namakkal - Dt. Tamil Nadu. Passport size
Photograph
Phone : 04288 - 294089, Fax : 04288 - 263602
Mob : 98427 - 13789, 99655 - 77789
Web : http://excelengg.org.in/ ; e-mail : aknatesan@yahoo.com

COUR SE : BR ANCH :

1. Name: Mr./Miss/ Mrs. :

(Block Letters)

2. Sex (Male / Female) :

3. Address With Pin Code & Telephone No. :

4. Father's Name & Mobile No. :

5. Mother's Name :

6. a) Permanent address of Parent/Guardian :

b) Occupation & Annual Income :

7. a) Address of the Local Guardian (if any) :

(With Phone No.)

8. Date of Birth of the Candidate :

9. Nationality :

10. Mother Tongue :

11. Native Place, Dist, & State :

12. Tick the Section of your community : OC / BC / OBC / MBC / DNC / SC / ST

13. Academic Records (Attach attested copies) :

Year & Period of Study
Aggregate School/College Regular /
Examination Month of T.C.No.
% of Marks University From To Private
Passing

+2 / PDC /
Equivalent
10/SSLC

14. Studied Mathematics up to the level : SSLC / PUC / HSC / PDC / DEGREE
15. Registration Fee (Payable by Cash or DD : DD No. Dt.
drawn on "Excel Engineering College"
Payable at Komarapalayam or Bhavani

16. Do you require Hostel facilities : Yes / No

17. Whether you have appeared for any

Entrance examinations :

18. Academic Honors, Prizes etc., :

19. Knowledge in Computer Languages :

20. Extra curricular activities :

21. Any additional relevant information :

JOINT DECLARATION BY THE STUDENT AND THE PARENT

I declare that the statements given above are true and correct.
I have gone through the prospectus thoroughly, the prospectus was read and explained to us including the rules,
regulations, course details, recognitions, fees details, examination, board / university details, hostel, mess rules and
all other contents given in the prospectus, information bulletin and all pages of the application for admission.
I shall pay all my dues in time and shall not claim any refund for any reason whatsoever. I know any fees / charges
/ dues / fines / paid by me are neither refundable nor transferable. In case, I am forced to discontinue for any
reason, after paying full / part of admission fee / or any charges to the College, I know that I have to pay the balance
of fees for the course. I know once if I join the College, I have to pay the entire fees of the course, for which I have
joined, whether I study or discontinue the studies, if any time, for any reason.
I know that I have to pay all my fees / dues / other charges in time, otherwise I have to pay fine as fixed by the
College. I also know that hostel rent and mess charges, as applicable, are to be paid, if I am residing in the College
hostel. I have to pay the hostel rent even if I stay for one day.
I also know that all Original Certificates are to be deposited with the College and it will be returned only after the
completion of the course and after full payment of the course fees / dues.

Place :
Date :

……………………………….. ……………………………….
Signature of Parent / Guardian Signature of Applicant

FOR OFFICE USE :

Application Eligible / Selected / Fee Receipt
Admitted on
Received on Not Eligible Not Selected No. & Date

Remarks :

Office Manager Admn. Officer Principal Director Vice-Chairman Chairman