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    Application No. 2017153346: Application Form For VITEEE - 2017

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    ஆத்ம நேசினி
    Siva Raam. M has applied for VITEEE - 2017. He provides personal details like date of birth, gender, religion, nationality, community, mobile number, email, parent name, campus and test city preference. He is applying for regular study in English medium and has passed 12th class in March 2017 with PCME subjects from the Tamil Nadu Board of Higher Secondary Education. He has also provided his permanent and school addresses and signed the application form declaration. The payment acknowledgment shows that he paid Rs. 972.78 via netbanking/card on February 4, 2017 for his application under number 2017153346.

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    Application No. 2017153346: Application Form For VITEEE - 2017

    Uploaded by

    ஆத்ம நேசினி
    40 views1 page
    Siva Raam. M has applied for VITEEE - 2017. He provides personal details like date of birth, gender, religion, nationality, community, mobile number, email, parent name, campus and test city preference. He is applying for regular study in English medium and has passed 12th class in March 2017 with PCME subjects from the Tamil Nadu Board of Higher Secondary Education. He has also provided his permanent and school addresses and signed the application form declaration. The payment acknowledgment shows that he paid Rs. 972.78 via netbanking/card on February 4, 2017 for his application under number 2017153346.

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    Siva Raam. M has applied for VITEEE - 2017. He provides personal details like date of birth, gender, religion, nationality, community, mobile number, email, parent name, campus and test city preference. He is applying for regular study in English medium and has passed 12th class in March 2017 with PCME subjects from the Tamil Nadu Board of Higher Secondary Education. He has also provided his permanent and school addresses and signed the application form declaration. The payment acknowledgment shows that he paid Rs. 972.78 via netbanking/card on February 4, 2017 for his application under number 2017153346.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    40 views1 page

    Application No. 2017153346: Application Form For VITEEE - 2017

    Uploaded by

    ஆத்ம நேசினி
    Siva Raam. M has applied for VITEEE - 2017. He provides personal details like date of birth, gender, religion, nationality, community, mobile number, email, parent name, campus and test city preference. He is applying for regular study in English medium and has passed 12th class in March 2017 with PCME subjects from the Tamil Nadu Board of Higher Secondary Education. He has also provided his permanent and school addresses and signed the application form declaration. The payment acknowledgment shows that he paid Rs. 972.78 via netbanking/card on February 4, 2017 for his application under number 2017153346.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Application form for VITEEE - 2017

    Application No.

    2017153346
    Candidate Name : SIVA RAAM. M
    Date of Birth 08-03-2000 Gender MALE
    Religion Hinduism Nationality Indian
    Blood group B+ Mother Tongue Tamil
    Community OBC / BC Nativity Tamil Nadu
    Mobile No. 8903009065 Email ID. [email protected]
    Parent name R. Moorthy Hostel required Yes
    Campus Choice Chennai Test city Kumbakonam
    Mode of study Regular Medium of Instruction English
    Qualifying Exam 12th Class Month & Year passing Mar - 2017
    Exam Roll no. 587269 Subject Code PCME
    Name of the Board 24-TAMIL NADU BOARD OF HIGHER SECONDARY EDUCATION
    Permanent Address No.3 shanthi nagar,, shanthi nagar, kumbakonam, Thanjavur, Tamil Nadu-612001
    Address of the school New railway road, kumbakonam, Thanjavur, Tamil Nadu-612001
    DECLARATION
    I solemnly and sincerely affirm that I am Indian National / PIO/OCI Holder and that all particulars furnished by me in this application form are true and correct.
    I have not concealed any information.However, in the event of any information being found to be incorrect, fraudulent or untrue, either before or after the
    examination or after my admission to the programme, i understand that I am liable to face criminal prospection and the management can claim all authority to
    cancel my candidature / selection or admission as the case may be and I would have to forgo my seat and the fees.I will pay the required Tuition fees and the
    Hostel fees within the stipulated time to ensure my admission in VIT University. I agree to abide by the rules and regulations governing the examination as well
    as the rules pertaining to the refund of Tuition and Hostel fees contained in the brochure. I further undertake to submit all the required certificates as per the rule,
    either at the time of counseling or during the admission process, failing which I understand that I would have to forego my seat and the fees. I have read the
    brochure and understood the contents in general and the method Equipercentile Equating in particular. I accept this method to be adopted for Merit List
    preparation by VIT. I understand that all information related to VIT application form and VIT exam will be only sent through the valid mobile numbers as
    provided by me in the same form. I am also aware of the refund policy that the counseling processing fee of Rs.10,000/- is non-refundable.

    Signature of the candidate

    Payment Acknowledgment Copy

    Payment Option Made Netbanking/Credit/Debit Card

    Application No. 2017153346

    Candidate name SIVA RAAM. M

    Transaction No. 295422935

    Application Fee Rs. 970.00

    Transaction Amount Rs. 972.78 (includes banking service charge & service tax)

    Transaction Date & Time 04-02-2017 17:50:54

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