GOVERNMENT OF TAMIL NADU

DIRECTORATE OF TECHNICAL EDUCATION

TAMIL NADU ENGINEERING ADMISSION - 2023
Application for Admission to B.E/B.Tech Degree Course
Application Number: 328420

Personal Information
Name: GURU PRASATH Name of the Parent/Guardian: krishna moorthy
Communication Address: 16/9E majeeth road, 2nd corss street , sivagangai Permanent Address: 16/9E majeeth road, 2nd corss street , sivagangai
State: Tamil nadu District: Sivaganga
Taluk: Sivagangai Communication address pincode: 630561
Native District: Sivaganga Civic status of Native Place: Municipality
Date of Birth (DD-MM-YYYY): 09-11-2005 Gender: Male
Mother Tongue: Tamil Nationality: Indian
Nativity: Tamil nadu Religion: Hindu
Name of the Community: BC Name of the Caste: Agamudayar including Thozhu or Thuluva Vellala
Aadhar Number (optional): 210182053605

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:
Alagappa Government Polytechnic College,Karaikudi – 630 004.

Scholarship Information
Parent Occupation: Agriculture Annual Income: 60000
Are you a First Graduate?: Yes Post Matric Scholarship (SC/SCA/ST/Converted Christians): No

School of Study Information

Category of School: Private Civic status of school location (+2): Village Panchayat
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. 2017 Bodhi International School Sivaganga Tamil nadu Kalayarkoil --

VII Std. 2018 Bodhi International School Sivaganga Tamil nadu Kalayarkoil --

VIII Std. 2019 Bodhi International School Sivaganga Tamil nadu Kalayarkoil --

IX Std. 2020 Bodhi International School Sivaganga Tamil nadu Kalayarkoil --

X Std. 2021 Bodhi International School Sivaganga Tamil nadu Kalayarkoil --

XI Std. 2022 Bodhi International School Sivaganga Tamil nadu Kalayarkoil --

XII Std. 2023 Bodhi International School Sivaganga Tamil nadu Kalayarkoil --

Academic Information
Qualifying Examination: CBSE Name of the Board of Examination: Central Board of Secondary Education
Permanent register number: -- HSC Roll number: 20669213
Qualified Year: 2023 HSC Group: --
Group Code: Physics/ Chemistry/ Maths/ Optional Subject (0001) Medium of Instruction: Tamil
HSC maximum (total) marks: 500 HSC obtained marks: 283
SSLC maximum (total) marks: 500 SSLC obtained marks: 313
Have you applied for NEET ?: Yes Have you applied for JEE ?: Yes
Educational Management Information System(EMIS) Number: -- Community certificate number: ECCC67896A687C86
Nativity certificate number (if applicable): --
 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSION - 2023
Application for Admission to B.E/B.Tech Degree Course
Application Number: 328420

Subjects Permanent Register Number/Roll Month Year Maximum Mark Obtained Mark
Number

Physics 20669213 March 2023 100 53

Chemistry 20669213 March 2023 100 60

Mathematics 20669213 March 2023 100 54

Optional 20669213 March 2023 100 58

 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSION - 2023
Application for Admission to B.E/B.Tech Degree Course
Application Number: 328420

DECLARATION BY THE APPLICANT

I, GURU PRASATH (Son / Daughter) of KRISHNA MOORTHY 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, KRISHNA MOORTHY (Parent / Guardian) of GURU PRASATH 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 - 2023
Application for Admission to B.E/B.Tech Degree Course
Application Number: 328420

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 BC (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