ST.

ANNE'S ARTS & SCIENCE COLLEGE

( AFFILIATED TO UNIVERSITY OF MADRAS )
G.N.T Road, Ponniammanmedu, Madavaram, Chennai- 600110.
ISO 9001:2005 CERTIFIED INSTITUTION Affix Passport
Phone : 044-25583529 / 25584529
size photograph
Serial No

Reg. No. BCACA/2020/2175

Date. 26 Jul 2020

BCA COMPUTER APPLICATIONS

1. NAME (IN BLOCK LETTERS) : MALATHI C

as in the qualifying Examination
with expansion of initials

2. Residential Address : 94/2 Main road sengadu

3. Mobile No : 8526678549

4. email : [email protected]

5. Date of Birth : 05 Sep 2002

6. Religion,Nationality : Hinduism, Indian

7. Blood Group : A+

8. Community , Caste : BC, Agamudhayar

( Copy of the Community Certificate must by enclosed )

9. Name of School last studied : vallal S.I.Alagarswami chettiyar higher sec

school

10. Year of Course Completed : 2020

11. Medium of Instruction last studied : Tamil

12. Statement of marks of the qualifying examination.

Board : STATE BOARD
Exam register number : 2781169

MONTH AND
MAX. MARKS
SUBJECT YEAR OF
MARKS OBTAINED
PASSING
Part I Lanuage 100 91 Jun 2020

Part II Lanuage 100 36 Jun 2020

physics 100 50 Jun 2020

chemistry 100 47 Jun 2020

Biology 100 51 Jun 2020

Mathematics 100 35 Jun 2020

Total (Only the main subject) 400 183

( To be attested if photo copy of orginal marksheet is not enclosed )

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13. Part1 Language : Tamil
( Basic knowledge of the language is essential )

PARTICULARS FATHER MOTHER

Name Chandrasekaran C. Geetha

Occupation security supervisor House wife

Occupation Address 94/1 main road sengadu 94/1 main road sengadu

Annual Income 48000 -

Mobile Number 8526678549 -

14. Sports / Games activities : -

15. If differently abled, specify? : No

16. Whether Parent is Ex-Service Man ? : No

17. Whether First Generation Learner ? : No

18. Whether any Other Courses applied for in this : No

college ?

19. Personal Identification Mark - 1 :

20. Personal Identification Mark - 2 :

Photocopies of the following should be brought along with the filled in Application form
during the time of Admission.
- STD X & XI – Statement of Marks, STD XII or equivalent Certificate
- Pass Certificate (for CBSE and ISC Boards)
- Transfer Certificate and Conduct Certificate
- Community Certificate in the case of BC / BCM / MBC / DNC / SC / SCA / ST
- Certificate of proof for the differently abled /Sports / NSS / Ex – Servicemen etc.
- A Self Addressed stamp envelope
- Eight Passport size photographs and Soft Copy of your photo with white background
(i.e., Passport Size photo in CD)
- Three Photo copies of all the documents
- Copy of blood group report, Aadhar Card

Declaration
I declare that my admission is at my own risk and is provisional. It is subject to the approval of the
University of Madras. If, for any reason, I am found ineligible, I will not hold the College responsible.
I also declare that the particulars given above are correct.

Signature of applicant Signature of Father / Mother / Guardian

Date : 26 Jul 2020

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