DIRECTORATE OF OPEN AND DISTANCE LEARNING

TAMIL NADU AGRICULTURAL UNIVERSITY, COIMBATORE – 641 003 Affix recent passport
size (colour)
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Application form for admission of Certificate Courses

1. Name of the applicant (Both in English & :

Tamil)

2. Name of the Parent/ Guardian/ Husband :

3. Address for communication

Pin :

Phone No. / Mobile / e-mail :

4. Date of Birth : 5. Sex : Male Female Transgender

6. Mother Tongue : 7. Nationality :

8. Social Category : SC / ST / BC / OBC / Others

9. Educational Qualification :

10. Employment Status :

11. Registration Sought for :

12. SBCollect Reference No. :

13. Candidate’s Declaration

I hereby declare that the information stated in the application form is true, complete and correct to the
best of my knowledge. I hereby abide by the rules and regulations of the TNAU on the event of my admission.

Place : Signature of the applicant

Date :
Online Payment Ref.No.__________________Rs._________dt: __________Bank:______________
Note:
1. The registration fee (Rs.2,500/-) has to be paidonly through online payment on SBI Collect
2. Registration fee is not refundable and transferable
3. Accommodation and travel charges for attending the contact classes has to be met by the candidates
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