Postal

ANNA UNIVERSITY Stamp

D L 2 3 2 0 3 7 8

CENTRE FOR DISTANCE EDUCATION if sent By

Post
CHENNAI 600 025

APPLICATION FOR ADMISSION TO MBA / MCA / MSc(CS) DEGREE PROGRAMME THROUGH DISTANCE MODE

A) APPLICATION NO DL2320378

B) APPLICANT NAME AKSHITHA J

C) PROGRAMME APPLIED FOR MCA

D) APPLIED FOR ADMISSION ACADEMIC YEAR 2023

From To

THE DIRECTOR

CENTRE FOR DISTANCE EDUCATION

ANNA UNIVERSITY

CHENNAI-600 025

(Please Paste this page in the A4 Cover)

 APPLICATION NO - DL2320378
ANNA UNIVERSITY
CENTRE FOR DISTANCE EDUCATION D L 2 3 2 0 3 7 8

CHENNAI 600 025

APPLICATION FOR ADMISSION TO MBA/MCA/M.Sc. DEGREE PROGRAMME THROUGH DISTANCE MODE

1. Batch Applied for : ACADEMIC YEAR 2023

a. Programme applied for : MCA

b. Entrance Test Centre : CHENNAI

2. Name of the Candidate : AKSHITHA J

a. Father Name : JAWAHAR M

b. Address for Communication : 1984, 2ND CROSS STREET,

MAGELAM STREET, GERGUMBAKKAM

City : CHENNAI

District : Kancheepuram

State : Tamil Nadu

Pincode : 600122

Office Phone No. : -

Residence Phone No. : -

Mobile No. : 7550236798

Aadhar Number : 386783016378

Email Address : akshithaj1206@gmail.com

3. Date of Birth : 03/05/2003

4. Mother Tongue : TAMIL

5. Gender : FEMALE

6. Community : BC

7. Differently abled person : None

 8. Details of Educational Qualification

Description Certificate No Period of Study Month & Year of Name of the Institution Name of the Boardy
Passing
SSLC 0631625 2017-2018 05/2018 LALAJI MEMORIAL CBSE
OMEGA INTERNATIONAL
SCHOOL
HSC 0214344 2019-2020 07/2020 LALAJI MEMORIAL CBSE
OMEGA INTERNATION
SCHOOL
Diploma - - - - -
Bachelor - 2020-2023 08/2023 SRI RAMACHANDRA INSTITUTE OF HIGHER
Degree (UG) EDUCATION
Name of the UG Degree BACHELOR OF SCIENCE
Major Subject Bioinformatics
Percentage of the UG Degree 83.80
Name of the University Sri Ramachandra Medical College and Research Institute, Chennai
State of University(UG) Tamil Nadu

9. If you are an applicant for MCA/MSc(CS), have you studied Mathematics / Statistics : Yes
as one of the subjects at degree level or mathematics at +2 level

10. If possessing AMIE, do you have 2 years experience after the completion of AMIE : No
(Proof to be enclosed)

11. Tancet Candidates

i. Appeared For TANCET(2023) : Yes

ii. TANCET score : 33.667

12. Working Details

i. Are you working ? : No

ii. Name of the Organization : -

13. Details of Bank Account for Refund of Caution Deposit

Bank Account No :- Bank Account Type : -
Name of the Bank : - Branch :-
Bank IFS Code :-

14. Online Payment Details for Application Cost

Transaction ID : TxnA226594026752738315 Transaction Date : 23-08-2023
Amount : Rs.767.00/- (Including GST) Payment Status : Successful

DECLARATION
It is certified that to the best of my knowledge all the information furnished above are true. I am aware that any wrong
information or suppression of information in this application may result in punitive action in addition to the summary
cancellation of my candidature for the Entrance Test and Admission.
Place :
Date : Signature of the Candidate

Powered by TCPDF (www.tcpdf.org)