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APPLICATION FOR ADMISSION TO UNDERGRADUATE DEGREE PROGRAMS 2014-2015

1. Date of Birth

(DD/MM/YYYY)

2. Name of Candidate

(As in +2 Marksheet)

3. Gender

5. Father's Name

6. Mother's Name

7. Mailing Address

9. Category

10. (a) Code Number of the Caste

11.(a) Qualifying Examination Passed HSC(Academic)

HSC(Vocational)

CBSE/Equivalent

(b) SerialNo of HSC/CBSE/

Equivalent Marksheet

(c) No of Appearances

(Attempts) :

Tamil Nadu Agricultural University, Coimbatore - 641 003

APPLICATION No.

¨Male Female Othersþ ¨ 4. Place of Birth

PIN Code

8 Mobile Number

(Choose one)¨ BC ¨ BCM (Muslim) ¨ MBC/DNC þ SC SCA

¨ ST ¨ Open Competition

(b) Name of the Caste(See Appendix I of Brochure)

þ ¨

¨

26/06/1997

¨

Affix Passport

Size

Photograph

AGATHIYA K

KANNAN A

PATHIRAPULIYUR

JANAKI K

47, SIVAN KOIL STREET,

PATHIRAPULIYUR VILLAGE & POST,

TINDIVANAM TK,

VILLUPURAM DIST

604304

9025020546

0 ADI DRAVIDAR

9107842 1

2014132179

Email parthipeter7@gmail.com

*2014132179*

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HSC Academic

03

Mathematics

Obtained Maximum

Physics

Chemistry

Biology

Botany

Zoology

BioTech/Mic.Bio/

Bio.Chem/

Hom.Sci.

Vocational Group

Biology

Agriculture Practices

Theory

PracticaI I

Obtained Maximum

Practical II

01

02

04

08

06

10

09

05

11

Com. Science/ 07

200

200

200

200

13. Medium of Instruction : Tamil English

14. Nativity Tamil Nadu Other State If others, specify

15. Citizenship Indian Others If others, specify

16. Particulars of Institutions last studied

Academic Year

2013-2014 (XII)

2012-2013 (XI)

2011-2012 (X)

Name of the Institution Class Studied Place State

DECLARATION

Place :

Date :

(in qualifying Exams)þ ¨

þ ¨

þ ¨

Signature of the Parent / Guardian Signature of the Candidate

Digital Signature :

Certified that the information furnished above are correct and true to the best of my knowledge. If found otherwise, I

undertake to forego my candidature and seat in the University if selected. I do hereby undertake that, I am aware that

there is no JOB GUARANTEE, I will not claim any extra facilities like scholarship, stipend, etc ., which are not in

operation, I am willing to study in the degree and campus chosen by me during counseling and will not claim change

of degree / campus. I do hereby undertake to abide by the rules in vogue and orders of the authorities of the

University to pay the tuition and other fees as prescribed and revised from time to time. I understand that Counseling

fee and semester fees, once paid are not refundable.

21/05/2014

AGATHIYA K 21/05/2014 06:57 PM

12. Marks Obtained

Tick if 07 is Computer Science¨

110

122

126

137

TINDIVANAM

ST.PHILOMENA'S GIRLS HIGHER SECONDARY SCHOOL

ST.PHILOMENA'S GIRLS HIGHER SECONDARY SCHOOL

ST.PHILOMENA'S GIRLS HIGHER SECONDARY SCHOOL

X

XI

XII TINDIVANAM

TINDIVANAM

TINDIVANAM TAMILNADU

TAMILNADU

TAMILNADU

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INSTRUCTION TO APPLICANTS

1. Application fee of Rs. 600 (Rs. 300 for SC/SCA/ST) should be paid using SBI Collect online payment link and

select the Category: UG Aplication Fee.

2. SBI Collect : https://www.onlinesbi.com/prelogin/icollecthome.htm?corpID=343855

3. No paper communications will be sent as all of admission processes are ONLINE ONLY.

4. Those applying under Eminent Sports Person quota and NRI/Industry Sponsor quota should submit IN PERSON

the special application with necessary fee and encolosures as stipulated in the Information Brochure to the Dean

(Agriculture ) and Chairman Admissions,Tamil Nadu Agricultural University, Coimbatore -3 and verify certificates

before the application deadline.

4. Those applying under Differently ABLED quota, Decendents of Ex-Servicemen quota and Son/Daughter of

Freedom Fighter quota should post the special application with necessary fee and encolosures as stipulated in the

Information Brochure before the application deadline to:

The Dean Agriculture and Chairman Admissions

Tamil Nadu Agricultural University

Coimbatore-641003

5. Use Application Number for all references and keep login credentials safe.

6. Applications filed without online payment of application fee will summarily be rejected.