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Application Form /
ಅ

Applicant Full Name/ಅ ರರ Ibrahim Chowdry

ಣ ಸರು :

Photo(3.5cm x
4.5cm)/ ೕ ೂೕ(3.5cm x 4.5cm) :

Scheme/ ಜ : Semester/ ಸ

Register Number/ ೂೕಂದ ಸಂ : 380EE15009

College Code/ ೕಜು ೂೕ : 380

College Name/ ೕಜು ಸರು : N E SOCIETY POLYTECHNIC

College Location/ ೕಜು ಸಳ : RAJAPUR

E-Mail ID (E-Mail notifications will ibrahimchowdry155@gmail.com

be sent to this ID)/ಇ- ೕ ಐ ( ಇ-
ೕ ಸಂ ೕಶಗಳನು ಈ ಐ.
ಕಳು ಸ ಗು ದು) :

Mobile Number (SMS notifications 7204619176

will be sent to this number)/ ೖ
ಸಂ (ಎ .ಎಂ.ಎ ಸಂ ೕಶಗಳನು ಈ
ಸಂ ಕಳು ಸ ಗು ದು) :

Hidden DOB for eKYC : 14-01-2000

Particulars of Examination/ಪ ೕ ಯ ವರಗಳು

Particulars of Examination/ಪ ೕ ಯ ವರಗಳು

Semester/ ಸ Month of Examination/ಪ ೕ ಯ ಂಗಳು Year of Examination/ಪ ೕ ಯ ವಷ Result/ಫ ಂಶ

1 December/ ಂಬ 2015 Fail/ ೕ

1 May/ ೕ 2016 Fail/ ೕ

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 1 December/ ಂಬ 2016 Pass/

2 May/ ೕ 2016 Pass/

3 December/ ಂಬ 2016 Fail/ ೕ

3 May/ ೕ 2017 Fail/ ೕ

3 December/ ಂಬ 2017 Fail/ ೕ

3 May/ ೕ 2018 Fail/ ೕ

3 December/ ಂಬ 2018 Fail/ ೕ

3 May/ ೕ 2019 Fail/ ೕ

3 December/ ಂಬ 2019 Pass/

4 May/ ೕ 2017 Fail/ ೕ

4 December/ ಂಬ 2017 Fail/ ೕ

4 May/ ೕ 2018 Fail/ ೕ

4 December/ ಂಬ 2018 Fail/ ೕ

4 May/ ೕ 2019 Fail/ ೕ

4 December/ ಂಬ 2019 Pass/

5 December/ ಂಬ 2018 Pass/

6 May/ ೕ 2019 Fail/ ೕ

6 December/ ಂಬ 2019 Pass/

Date of result announcement of February 2020

final examination taken (including
all attempts)/ಅಂ ಮ ಪ ೕ ಯ
ಫ ಂಶದ ಪ ಕಟ ಯ ಂಕ :

Selected College : N E SOCIETY POLYTECHNIC - 380

Declaration /
ೂೕಷ

I hereby declare that the particulars furnished in this form are true to the best of my knowledge/ಈ ಅ ಯ ನನ
ಅ ಂದ ಒದ ರುವ ಎ ವರಗಳು ೖಜ ರುತ ಎಂದು ೂೕ ಸು ೕ .

Page 2 of 25
 I Agree : Yes

Annexure List

1) Photocopy of SSLC or 10th Marks Card Photocopy

Standard Marks Card

2) Attested Marks Card 1 of Semester Marks Card Photocopy

or Year

3) Attested Marks Card 2 of Semester Marks Card Photocopy

or Year

4) Attested Marks Card 3 of Semester Marks Card Photocopy

or Year

5) Attested Marks Card 4 of Semester Marks Card Photocopy

or Year

6) Attested Marks Card 5 of Semester Marks Card Photocopy

or Year

7) Attested Marks Card 6 of Semester Marks Card Photocopy

or Year

8) Attested Marks Card 7 of Semester Marks Card Photocopy

or Year

9) Attested Marks Card 8 of Semester Marks Card Photocopy

or Year

10) Attested Marks Card 9 of Semester Marks Card Photocopy

or Year

11) Attested Marks Card 10 of Marks Card Photocopy

Semester or Year

12) Attested Marks Card 11 of Marks Card Photocopy

Semester or Year

13) Attested Marks Card 12 of Marks Card Photocopy

Semester or Year

14) Attested Marks Card 13 of Marks Card Photocopy

Semester or Year

15) Attested Marks Card 14 of Marks Card Photocopy

Semester or Year

16) Attested Marks Card 15 of Marks Card Photocopy

Semester or Year

Page 3 of 25
17) Attested Marks Card 16 of Marks Card Photocopy
Semester or Year

18) Attested Marks Card 17 of Marks Card Photocopy

Semester or Year

19) Attested Marks Card 18 of Marks Card Photocopy

Semester or Year

20) Attested Marks Card 19 of Marks Card Photocopy

Semester or Year

21) Attested Marks Card 20 of Marks Card Photocopy

Semester or Year

Additional Details

Apply to the Office Polytechnic Institutions Office(Polytechnic Institutions- N E SOCIETY

POLYTECHNIC - 380 )

Draft Reference No : TE001S220013184

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