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Application Form for Admission to Amrita B.Tech Admissions 2020

Amrita School of Engineering-Amrita Vishwa Vidyapeetham
(Data filled by the candidate on 21/12/2019 4:23 PM)

PERSONAL INFORMATION ADDRESS FOR CORRESPONDENCE

Candidate Name : PARTHIBAN Address Line 1 : 1/D KAMARAJAR NAGAR,
Gender : Male 2NDCROSS
Date of Birth : 2002-03-08 Address Line 2 : THANTHONIMALAI
Social Status : OBC(BC&MBC) Pincode : 639005
Email Address : parthiban832002@gmail.com State : Tamil Nadu & Puducherry (UT)
Mobile Number : +91 8124908669 District : Karur
Alternate Email : parthibanssv832@gmail.com City : Thanthoni
Aadhar Number : 810857194096
Nationality : Indian
Parent’s / Guardian’s Name : CHANDRASEKAR
Parent’s / Guardian’s Mobile No : +91 9585917852
How did you know about Amrita ? : Google

ACADEMIC QUALIFICATIONS
School Last attended Plus Two Board Plus Two State
Sri Sankara Vidyalayaa Senior Secondary CBSE Tamil Nadu & Puducherry (UT)
School

AEEE DETAILS
Entrance Examination Mode : Computer Based Test
Exam City Choice 1 : Karur
Exam City Choice 2 : Namakkal
Exam City Choice 3 : Erode

OTHER DETAILS
Preferred Campus : Coimbatore
Do you wish to stay in hostel ? : Yes
Do you need Bus Facility ? : No

DECLARATION

I PARTHIBAN son/daughter of CHANDRASEKAR do hereby declare that the facts given by me in the application are true. I shall produce the original
certificates at the time of admission or on demand

Place:

Date:

Signature of the Candidate

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