ity Institute Name Navalurkuttapatty, Srirangam(TK), Tiruchirapy Constituent A College, alli-620027, STUDENT DETAILS PROFORMA (For University Ex: m Purpose) Name of the Applicant English (Ex: KAVITHA ISELVAN K) Photo Name of the Applicant Hamil (Ex: &ONST Qesveustt &) Course Roll Number Board in School Medium of School |Andhaar No hallenged (Yes! Visually Challenged (Ves! No) Mother Tongue M 1 Status ther / Guardian Name Bioms ! . uTgyemeusot Quy Mother Name Father / Guardian Occupation Rel igion Community mente lnxcascarsce) Sub Caste Gender of my knowledge and belief. Hand Writing Address Distriet City/Pown/Village Pin Code Mobile N Declaration: I hereby declare that all statements made in this application are true, complete and correet to the best Student Signature Class Incharge H.O.D