GOVERNMENT OF TAMIL NADU

DIRECTORATE OF TECHNICAL EDUCATION

TAMIL NADU ENGINEERING ADMISSIONS - 2024
Application for Admission to B.E/B.Tech Degree Course
Application Number: 256396

Personal Information
Name: KUTRALA SELVAN V Name of the Parent/Guardian: VEERAPANDIAN K
Communication Address: Permanent Address:
VANAMOORTHILINGAM PILLAI STREET,MUHAVUR,RAJAPALAYAM TK,VIRUDHU- VANAMOORTHILINGAM PILLAI STREET,MUHAVUR,RAJAPALAYAM TK,VIRUDHU-
NAGAR DT-626188 NAGAR DT-626188
State: Tamil nadu District: Virudhunagar
Taluk: Rajapalayam Communication address pincode: 626188
Native District: Virudhunagar Civic status of Native Place: Village Panchayat
Date of Birth (DD-MM-YYYY): 14-04-2007 Gender: Male
Mother Tongue: Tamil Nationality: Indian
Nativity: Tamil nadu Religion: Hindu
Name of the Community: BC Name of the Caste: Senaithalaivar, Senaikudiyar and Illaivaniar
Aadhar Number (optional): 537778781645

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:
PAC Ramasamy Raja's Polytechnic College,Rajapalayam - 626 108

Scholarship Information
Parent Occupation: Others Annual Income: 84000
Are you a First Graduate?: Yes Post Matric Scholarship (SC/SCA/ST/Converted Christians): No
Are you planning to avail education loan?: Y

School of Study Information

Category of School: Govt. Aided 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. 2018 T.n.p.m.marimuthu Nadar Hr.sec.school, Virudhunagar Tamil nadu Rajapalayam --

Thalavaipuram

VII Std. 2019 T.n.p.m.marimuthu Nadar Hr.sec.school, Virudhunagar Tamil nadu Rajapalayam --
Thalavaipuram

VIII Std. 2020 T.n.p.m.marimuthu Nadar Hr.sec.school, Virudhunagar Tamil nadu Rajapalayam --
Thalavaipuram

IX Std. 2021 T.n.p.m.marimuthu Nadar Hr.sec.school, Virudhunagar Tamil nadu Rajapalayam --

Thalavaipuram

X Std. 2022 T.n.p.m.marimuthu Nadar Hr.sec.school, Virudhunagar Tamil nadu Rajapalayam --

Thalavaipuram

XI Std. 2023 T.n.p.m.marimuthu Nadar Hr.sec.school, Virudhunagar Tamil nadu Rajapalayam --

Thalavaipuram

XII Std. 2024 T.n.p.m.marimuthu Nadar Hr.sec.school, Virudhunagar Tamil nadu Rajapalayam --
Thalavaipuram

Academic Information
Qualifying Examination: TN-HSC Name of the Board of Examination: Tamil nadu Board of Higher Secondary Education
Permanent register number: -- HSC Roll number: 6111740
Qualified Year: 2024 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: -- SSLC obtained marks: --
Have you applied for NEET ?: No Have you applied for JEE ?: No
 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSIONS - 2024
Application for Admission to B.E/B.Tech Degree Course
Application Number: 256396

Have you applied for Indian Maritime University Common Entrance Test (IMU Educational Management Information System(EMIS) Number:
CET)?: 3326061279200214
No
Community certificate number: B9D96E8C6A687D86 Nativity certificate number (if applicable): --
 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSIONS - 2024
Application for Admission to B.E/B.Tech Degree Course
Application Number: 256396

DECLARATION BY THE APPLICANT

I, KUTRALA SELVAN V (Son / Daughter) of VEERAPANDIAN K 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, VEERAPANDIAN K (Parent / Guardian) of KUTRALA SELVAN V 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 ADMISSIONS - 2024
Application for Admission to B.E/B.Tech Degree Course
Application Number: 256396

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