GOVERNMENT OF TAMIL NADU

DIRECTORATE OF TECHNICAL EDUCATION

TAMIL NADU ENGINEERING ADMISSION - 2022
Application Number: 299562

Personal Information
Name: G.V.NISANTH Name of the Parent/Guardian: G VISHNUKUMAR
Communication Address: Permanent Address: NO.1 SANTHI AVENUE ,KANNANKURICHI MAIN ROAD
NO.1 SANTHI AVENUE ,KANNANKURICHI MAIN ROAD SALEM-636008
SALEM-636008
State: Tamil nadu District: Salem
Taluk: Salem Communication address pincode: 636008
Native District: Salem Civic status of Native Place: Corporation
Date of Birth (DD-MM-YYYY): 11-09-2005 Gender: Male
Mother Tongue: Tamil Nationality: Indian
Nativity: Tamil nadu Religion: Hindu
Name of the Community: SC Name of the Caste: Adi Dravida
Aadhar Number (optional): 290717554959

Special Reservation Information

Whether you are a candidate under quota for Eminent Sports person as per Ex-Servicemen (Only Army/Navy/ Air force services are Eligible): No
annexure-II, item No.22 of information brochure?:
No
Differently Abled Person: No Differently Abled Type: --
TFC Center for certificate verification:
Government College Of Engineering , Karuppur, Omalur, Salem - 636 011

Scholarship Information
Parent Occupation: Business Annual Income: 200000
Are you a First Graduate?: No Post Matric Scholarship (SC/SCA/ST/Converted Christians): No

School of Study Information

Category of School: Private Civic status of school location (+2): Corporation
Have you studied VIII to XII in Tamil Nadu?: Yes Have you studied from VI to VIII in private school under RTE and IX to XII in
Government School?:
No
Have you studied VI to XII in Government school?: No

Class Year of Passing Name of the school District State Block Category of
Govt.School

VI Std. 2016 st.john's matric hr. sec. school,new- Salem Tamil nadu Salem-Urban --
alagapuram

VII Std. 2017 st.john's matric hr. sec. school,new- Salem Tamil nadu Salem-Urban --
alagapuram

VIII Std. 2018 Holy Cross Matric Hr. Sec. School, K.n. Salem Tamil nadu Ayothiyapattinam --
Colony

IX Std. 2019 Holy Cross Matric Hr. Sec. School, K.n. Salem Tamil nadu Ayothiyapattinam --
Colony

X Std. 2020 Holy Cross Matric Hr. Sec. School, K.n. Salem Tamil nadu Ayothiyapattinam --
Colony

XI Std. 2021 Holy Cross Matric Hr. Sec. School, K.n. Salem Tamil nadu Ayothiyapattinam --
Colony

XII Std. 2022 Holy Cross Matric Hr. Sec. School, K.n. Salem Tamil nadu Ayothiyapattinam --
Colony

Academic Information
Qualifying Examination: HSC Name of the Board of Examination:
Tamil nadu Board of Higher Secondary Education
Permanent register number: 2111315703 HSC Roll number: 5315109
Qualified Year: 2022 HSC Group: HSC Academic
Group Code: Physics/ Chemistry/ Maths/ Biology Medium of Instruction: English
HSC maximum (total) marks: -- HSC obtained marks: --
SSLC maximum (total) marks: 500 SSLC obtained marks: 483
Have you applied for NEET ?: Yes Have you applied for JEE ?: No
Educational Management Information System(EMIS) Number: Community certificate number: 5540285
3308210020503766
 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSION - 2022
Application Number: 299562

Nativity certificate number (if applicable): --

 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSION - 2022
Application Number: 299562

DECLARATION BY THE APPLICANT

I, G.V.NISANTH (Son / Daughter) of G VISHNUKUMAR hereby solemnly declare that the information furnished and the statements
given in the application and the enclosures are true, correct and complete. I further declare that should it be found otherwise, I will
be liable to forfeit my seat and / or removal from the rolls of the Institution at whatever stage of study I may be, besides making me
liable for criminal prosecution. I am fully aware that as per the directions of the Hon'ble Supreme Court of India and Tamil Nadu
Prohibition of Ragging Act 1997, Ragging is an offence, as is banned in the Institutions and anyone indulging in ragging is liable
to be punished such as expulsion from the Institutions and / or rigorous imprisonment up to 3 years, and / or fine up to Rs.25,000/-

Place:

Date: ( Signature of the Applicant )

DECLARATION BY THE PARENT/ GUARDIAN

I, G VISHNUKUMAR (Parent / Guardian) of G.V.NISANTH hereby solemnly declare that I am fully aware of the declaration made
by the applicant, and I declare and bind myself on the same terms contained in the above declaration. The statements and the
information given are true, correct and complete. If it is found otherwise, the applicant is liable to forfeit the seat and / or removal
from the rolls of the Institution at whatever may be the stage of study, besides making me liable for criminal prosecution I am fully
aware that as per the directions of the Hon'ble Supreme Court of India and Tamil Nadu Prohibition of Ragging Act 1997,Ragging
is an offence, as is banned in the Institutions and anyone indulging in ragging is liable to be punished such as expulsion from the
Institution and / or rigorous imprisonment up to 3 years, and / or fine up to RS. 25,000/-

Place:

Date: ( Signature of Parent / Guardian )

Note: Guardian can execute the above declaration, only if both the parents are not alive.
 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSION - 2022
Application Number: 299562

The following Certificates copy have to be uploaded to our system.

1. Transfer certificate
2. 10th Mark Sheet
3. 12th Mark Sheet
4. Permanent Community Certificate Card for SC (Permanent card / Electronic form / Digitally Signed E-Certificate)
5. Income Certificate of the Parent
6. Special Reservation Form for Sports and relevant certificates
7. Special Reservation Form for Ex-Serviceman and relevant certificates
8. Special Reservation Form for Blindness & Low Vision and relevant certificates