MADURAI KAMARAJ UNIVERSITY

EVENING COLLEGE
Alagarkoil Road, Madurai – 625 002

M.A. English, M.Sc., Mathematics and M.B.A.,

Programmes
2021-22
Application No:

Course Applied For

Applicant’s
Photograph
1. Name of the Applicant In English..…
Photograph must be
(IN BLOCK LETTERS) In Tamil …… signed by the
candidate ( at the top)
and Attested by a
Gazetted Officer (at
the bottom)
2. Gender: Male/Female/Transgender 3. Date of Birth and Age:

4. Place of Birth, District and State:

5. Nationality and Religion: 6. Aadhar Number:

7. Mother Tongue: 8. Blood Group:

9. Community OC/BC/BC (Muslim) /MBC/DNC/SC/SCA/ST

(Enclose attested copy of the community certificate)

10. a) Name of the Father / Guardian: Cell No:

b) Name of the Mother / Guardian: Cell No:
c) Occupation of the Parent /Guardian:
d) Annual Income of the Parent /Guardian:

Address for Communication Permanent Address

Phone: Phone:

11. Email id: Cell / WhatsApp Number:

[P.T.O]

   
12. Educational Qualification ( since SSLC) Strike out those not applicable
Si. Course / Certificate Subject Institution / Board Year of % Marks/
No. Passing Grade
1 SSLC
2 HSC
3 BA/B.Sc./BBA/B.Com
Office Seal:
Signature of the Attesting Officer
Name :
Designation :

13. Enclose Photo Copies of the following:

a. All Educational Qualification Certificates with their respective Mark Statements
b. Transfer Certificate c. Community certificate
Also enclose: One self addressed stamped Envelope of size 28 cm x 13 cm for Rs.10 and Three Passport size Photos.

Note: i) DO NOT SEND The Original certificates ii) Application without required enclosures will not be entertained.

DECLARATION OF THE CANDIDATE

I do hereby declare that the particulars furnished in the application are correct and true and that I
shall abide by the rules and regulations of the College.

Date: Signature of the Applicant

FOR OFFICE USE ONLY

The following originals are verified

1. Transfer Certificate 2. Community Certificate

3. SSLC Marksheet 4. HSC Mark sheet
5. UG Degree Certificate

All Original Certificates are returned to the candidate except TC

Name and signature of the verifying officer Name and signature of the candidate.

Fee Details P.G Course :

1. Amount Paid
2. Date Paid