FOR OFFICE USE ONLY

FOR OFFICE USE ONLY

Application No. : 2003570 Admission No.
Challan No. : 229128321 Programme
Date : 07/09/2020 Class No.

APPLICATION FOR ADMISSION TO UNDER GRADUATE PROGRAMMES 2020 - 2021

1 Name : STANTON ANTONY

2 Gender : MALE
3 Date of Birth : 05-12-2001
4 Nationality : INDIAN
5 Domicile State : KERALA
6 Religion : CHRISTIAN
7 Caste : LATIN CATHOLIC FOR OFFICE USE ONLY
8 Category : LATIN CATHOLIC OTHER THAN ANGLO INDIAN Quota
9 Name of Father : JOSEPH ANTONY Rank No
Occupation : COMPANY JOB Additional
10 Name of Mother : JANCY ANTONY Language
Occupation : Homemaker Signature
11 Permanent Address : CHELAT HOUSE,
EAST OF GOV HOSPITAL, NARAKKAL, ERNAKULAM
KERALA , INDIA, 682505
12 Present Address : CHELAT HOUSE,
EAST OF GOV HOSPITAL, NARAKKAL, ERNAKULAM
KERALA , INDIA, 682505
13 Land Phone :
Mobile : 9020604061
14 E-Mail : stantonantony10@gmail.com
15 Eligibility For Bonus Marks :

16 Sponsored by Union : No
Territory of Lakshadweep
17 Claim for Reservation :
 Marks
Exam Reg. No Year Name of Board
Percentage Secured Maximum
Plus Two 7141321 2020 KERALA STATE BOARD/VHSE 65.83 790 1200
X 483420 2018 KERALA STATE BOARD/VHSE 86.67 78 90

Statement of Plus Two Marks

Name Of Subject Marks Secured Maximum Marks
ENGLISH 135.00 200.00
MALAYALAM 139.00 200.00
PHYSICS 127.00 200.00
CHEMISTRY 134.00 200.00
BIOLOGY 148.00 200.00
MATHEMATICS OF SCIENCE GROUP 107.00 200.00
Total Marks 790.00 1200.00

18 No.of Chances taken to pass plus two : 1

19 Preference Details
Preference No Programme Second Language
1 B Sc BOTANY AIDED MALAYALAM
2 B Sc CHEMISTRY AIDED MALAYALAM
3 B Sc MATHEMATICS AIDED MALAYALAM
4 B Sc ZOOLOGY AIDED MALAYALAM
5 B Sc PHYSICS AIDED MALAYALAM

DECLARATION
I hereby declare that the information furnished above is true to the best of my knowledge. If granted admission, I agree to abide by
the rules and regulations of the College

Place :
Date : Signature of Parent/Guardian Signature of Candidate

FOR OFFICE USE ONLY

The applicant may be admitted to the first semester
Programme :

Second Language :

Date : Head of the Department Principal