APPLICATION FORM FOR ADMISSION TO APPLICATION NO :

GOVERNMENT POLYTECHNIC COLLEGE 2020 FY20 114291

Candidate Name YASMIN AR

Father’s/Guardian’s Name ABIBUR RAHMAN

Mother Tongue TAMIL

Father’s/Guardian’s Occupation BUSINESS

Date of Birth 2/5/1990

Age 30

Gender FEMALE

Citizenship INDIAN

Nativity த நா (TAMIL NADU)

Civic Native MUNICIPALITY

Religion MUSLIM

Community BCM

372-LABBAIS INCLUDING ROWTHAR AND MARAKAYAR

Caste (WHETHER THEIR SPOKEN LANGUAGE IS TAMIL OR
URDU)

10 MUNICIPAL QUARTERS, OOTY, NILGIRIS , TAMIL

Communication Address
NADU,643001

10 MUNICIPAL QUARTERS, OOTY, NILGIRIS , TAMIL

Permanent Address
NADU,643001

Mobile Number 9566143213

Email Id NITHYARAGHURAM2020@GMAIL.COM

Aadhar Number

SPECIAL RESERVATION

Differently Abled Eminent Sports Person Ex-Servicemen

NO NO NO
CIVIC INFORMATION

Mother Tongue Medium Of Instruction Parent Occupation

TAMIL ENGLISH BUSINESS

Civic Native Civic School Native District

MUNICIPALITY MUNICIPALITY த நா (TAMIL NADU)

DETAILS OF INSTITUTE LAST STUDIED

Name of the Institute District

NAZARETH NILGIRIS

Register No. Board

4532 STATEBOARD

STUDY DETAILS

STANDARD SCHOOL NAME YEAR OF PASSING DISTRICT STATE

6th NAZARETH 2010 NILGIRIS TAMIL NADU

7th NAZARETH 2011 NILGIRIS TAMIL NADU

8th NAZARETH 2012 NILGIRIS TAMIL NADU

9th NAZARETH 2013 NILGIRIS TAMIL NADU

10th NAZARETH 2014 NILGIRIS TAMIL NADU

MARKS OBTAINED IN QUALIFYING EXAMINATION

SUBJECT MARKS OBTAINED MAXIMUM MARKS

Tamil&Language 75 100

English 75 100

Maths 74 100

Science 76 100

SocialScience 90 100

Total 390 100

COLLEGE DETAILS

CHOICES COLLEGE SELECTED

112 - GOVERNMENT POLYTECHNIC COLLEGE, OOTY., INSTRUMENTATION AND CONTROL

1
ENGINEERING, The Nilgiris

Hostel Facility Needed NO

Women's Only YES

The following Original Certificate have to be produced at POLYTECHNIC CENTER, at the time of Certificate
Verification Venue, Date and Time will be initimated through SMS to registered mobile and Email Id.

1. Transfer Certificate

2. 10th Marksheet

3. SSLC Hall ticket

4. Permanent Community Certificate Card (Permanent card/electronic form/digitally signed e-certificate

5. Income Certificate of the Parent, if applicable

6. Nativity Certificate, if applicable

7. Special Reservation Form for Sports and relevant certificates, if applicable

8. Special Reservation Form for Ex-Serviceman and relevant certificates, if applicable

9. Special Reservation Form for Differently Abled and relevant certificates, if applicable

Kindly take the Printout of these Application, signed Declaration and Photocopies of the above mentioned certificates

need to be submitted at POLYTECHNIC CENTER, at the time of Certificate Verification.

 DECLARATION BY THE APPLICANT

I, YASMIN AR Son / Daughter of ABIBUR RAHMAN hereby solemnly declare that the information furnished in the
statements given in the application and the enclosures are true, correct and complete. False information will lead to
cancellation of Admission and Criminal Action.

Place:

Date:
(SIGNATURE OF APPLICANT)
Note:

1. Please do not enclose Original Certificates and enclose Photo copies of the Mark Sheet and Community
Certificate along with the Application Form.
2. Please visit www.tngptc.in for list of Government Polytechnic Colleges, Branches available, Eligibility Rules,
Selection Procedure etc., or contact respective Polytechnic Principals for details.
3. Application for Sponsored Quota Sandwich Courses should be sent to the respective Polytechnic College ‘ # ’ is
mentioned 1.3 in the Information to Candidates as published in www.tngptc.in

நா YASMIN AR ( ெபய ) த ைத ெபய ABIBUR RAHMAN ெத ப யாெத ண ப

ர ப ப ட தகவ க ம இத ட இைண க ப ள இைண க அைன உ ைமயானைவ
ம ச யானைவ எ உ அ ேற . ேம பர க ெபா யானைவ எ ன ெத ய வ தா
என ேச ைகைய ர ெச ய ,எ ற வழ ெதாடர இத ல ச மத ெத ேற .

Place (இட ):

Date (நா ):
(SIGNATURE OF APPLICANT)

( ண பதார ைகெயா ப )
Note:

1. ண ப க ட ம ெப ப ய ம சா சா த நக க ம இைண தா
ேபா மான .
2. அர பலவைக ெதா ப க க ப ய , பாட க ,த ம மாணவ கைள
ேத ெத ைற ஆ ய வர க ச ப த ப ட அர பலவைக ெதா ப க
த வ கைள ெதாட ெகா ள அ ல ெதா ப க இய கக இைணயதள கவ யான
www.tngptc.in - கா க.
3. ெதா ப ட ய ப டய ப ண ப கைள ச ப த ப ட க
த வ க அ பேவ .இ ெதாட பான வர க www.tngptc.in - இைணயதள
"Information to Candidates" - கா க.
 APPLICATION FORM FOR ADMISSION TO
GOVERNMENT POLYTECHNIC COLLEGE 2020

PAYMENT RECEIPT

APPLICATION NO 114291

CANDIDATE NAME YASMIN AR

PAYMENT REQ.ID 114291

TRANSACTION ID

TRANSACTION TIME

TRANSACTION Amount

The validity of this receipt is subject to realization of the amount in the POLYTECHNIC CENTRE Account.This is a
computer generated receipt and requires no signature. All kinds of refunds will be processed only by The Office of
Secretary, POLYTECHNIC CENTRE, after notification in the POLYTECHNIC CENTRE portal.