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: 242669

Personal Information
Name: SANJAY SV Name of the Parent/Guardian: VETRIVEL K
Communication Address: Permanent Address:
52,KALLORI NAGAR, 3RD CROSS, ANNA NAGAR, PEELAMEDU, COIMBATORE - 23/145, KUDI STREET, ARASUNILAIPALAYAM, MANAPPARAI, ANIYAPPUR,
641004 TIRUCHIRAPPALI, TAMILNADU - 621307
State: Tamil nadu District: Tiruchirappalli
Taluk: Manapparai Communication address pincode: 621307
Native District: Tiruchirappalli Civic status of Native Place: Village Panchayat
Date of Birth (DD-MM-YYYY): 20-06-2006 Gender: Male
Mother Tongue: Tamil Nationality: Indian
Nativity: Tamil nadu Religion: Hindu
Name of the Community: MBC & DNC Name of the Caste:
Urali Gounders (Tiruchirapalli, Karur, Perambalur, Ariyalur and Pudukottai Districts)
Aadhar Number (optional): 903599653220

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:
PSG College Of Technology, Peelamedu,Coimbatore – 641 004

Scholarship Information
Parent Occupation: Agriculture Annual Income: 100000
Are you a First Graduate?: No Post Matric Scholarship (SC/SCA/ST/Converted Christians): No
Are you planning to avail education loan?: N

School of Study Information

Category of School: Private Civic status of school location (+2): Corporation
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 Grg Matriculation Hr Sec School Coimbatore Tamil nadu Sarkar Samakkulam --

VII Std. 2019 Grg Matriculation Hr Sec School Coimbatore Tamil nadu Sarkar Samakkulam --

VIII Std. 2020 Grg Matriculation Hr Sec School Coimbatore Tamil nadu Sarkar Samakkulam --

IX Std. 2021 Grg Matriculation Hr Sec School Coimbatore Tamil nadu Sarkar Samakkulam --

X Std. 2022 Grg Matriculation Hr Sec School Coimbatore Tamil nadu Sarkar Samakkulam --

XI Std. 2023 Grg Matriculation Hr Sec School Coimbatore Tamil nadu Sarkar Samakkulam --

XII Std. 2024 Grg Matriculation Hr Sec School Coimbatore Tamil nadu Sarkar Samakkulam --

Academic Information
Qualifying Examination: TN-HSC Name of the Board of Examination: Tamil nadu Board of Higher Secondary Education
Permanent register number: 3258043 HSC Roll number: 6258043
Qualified Year: 2024 HSC Group: HSC Academic
Group Code: Physics/ Chemistry/ Maths/ Computer Science Medium of Instruction: English
HSC maximum (total) marks: 600 HSC obtained marks: 357
SSLC maximum (total) marks: 500 SSLC obtained marks: 312
Have you applied for NEET ?: No Have you applied for JEE ?: No
Have you applied for Indian Maritime University Common Entrance Test (IMU Educational Management Information System(EMIS) Number:
CET)?: 3312050020900119
No
TN-5201911135410 --
 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: 242669

Community certificate number: Nativity certificate number (if applicable):

Subjects Permanent Register Number/Roll Month Year Maximum Mark Obtained Mark
Number

Physics 3258043 March 2024 100 52

Chemistry 3258043 March 2024 100 58

Mathematics 3258043 March 2024 100 53

Optional 3258043 March 2024 100 59

 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: 242669

DECLARATION BY THE APPLICANT

I, SANJAY SV (Son / Daughter) of VETRIVEL 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, VETRIVEL K (Parent / Guardian) of SANJAY SV 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: 242669

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 MBC & DNC (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