33087

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Application No: 33087

Government of Kerala

DEPARTMENT OF TECHNICAL EDUCATION

APPLICATION FOR ADMISSION TOM.TECH / M.PLANNING / M.ARCH DEGREE COURSE 2016 - 2017

1. Name in CAPITAL Letters, beginning from the left; initials at the end of the name.(Please insert one letter in a box)S Y A M P R A S A D S

2. Postal Address Syam Nivas

Kurampala south P.O

Pandalam

Pathanamthitta

Affix recent

recent

passport size

photo

3 (a) Contact Telephone Number 4. Date of birth in Christian Era

STD Code Land Phone Day Month Year

1 9 0 1 1 9 9 5

Mobile No 9 4 4 6 9 3 5 3 7 7 E-mail ID [email protected]

5 Sex Is Keralite Religion Caste Reservation Category Non-Creamy

Layer

M Yes Hindu Vilakkithala Nair SEBC - Socially and

Educationally

Backward Classes

Yes

6 Details of GATE Examination passed

Year Reg.No. Score Mark

2016 CE16S51077150 362.00 26.13

7 Details of Qualifying Examination

Degree B.Tech

Branch Civil Engineering

University Kerala University

Name of the College Sri Vellappally Natesan College of Engineering

Is the College approved by AICTE Yes

Year of Passing 2016

Semwise Mark/SGPA Details

Semesters Marks/SGPA Scored Total Marks/SGPA

Sem 1 & 2 7.67 10.00

Sem 3 7.41 10.00

Sem 4 7.12 10.00

Sem 5 6.98 10.00

Sem 6 6.74 10.00

Total Marks in all Semesters up to and including sem 6 35.92

Maximum Marks in all Semesters up to and including sem 6 50

8 Fee Amount 500

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9 Whether Physically Challenged No

10 Sponsored Candidate No

11 Choice of specialisation in the order of preference

Choice College Specialisation Category

1 TKM College of Engineering, Kollam Structural Engineering &

Construction Management

GATE

2 MA College of Engineering,

Kothamangalam

Structural Engineering &

Construction Management

GATE

3 College of Engineering,

Thiruvananthapuram

Structural Engineering GATE

4 NSS College of Engineering,

Palakkad

Structural Engineering GATE

5 Government College of Engineering,

Kannur

Computer Aided Structural

Engineering

GATE

DECLARATION

(To be filled by the candidate)

I, ............................................................. hereby solemnly and sincerely affirm that the statements made and information

furnished in this application and also in the enclosures thereof submitted by me are true to the best of my knowledge and belief.I

hereby agree to abide by the rules and regulations of the college,if admitted.

Place:

Date: Signature of the Candidate

Note: 1.Late applications, those which do not contain the necessary documents specified in clause of the prospectus and in which any certificate is found defective, will

be rejected.

2.Those who have not secured qualification from the universities in Kerala state ,shall produce equivalency certificate at the time of admission/counseling.

List of Enclosures:

Self attested true copy of Engineering Degree certificate and Mark lists.

Self attested true copy of GATE Score card (for Candidates with valid GATE Score)

Self attested true copy of non creamy layer certificate for candidates who claim eligibility under SEBC(OBC)/OEC

Self attested true copy of Community certificate issued by the Tahsildar for candidates who claim eligibility for reservation under SC/ST quota.

Self attested true copy of Equivalency certificate for those who have not secured qualification from the Univeersities in Kerala.

Self attested true copy of Nativity Certificate.

Counterfoil of Chalan after remittance of application fee in any branch of SBT.

Additional Certifiates:

Self attested true copy of Sponsorship Certiciate for candidates applying under the sponsered category.

Self attested true copy of Physical Disability Certificate for candidates who claim eligibility under the Physical Disability quota.

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Instructions to Bank:Please note to enter the Application No and Student name in the mandatory fields while posting the amount in the Current Account.

STATE BANK OF TRAVANCORE Fee Payment Voucher

Bank Copy

Date:............................

Branch:Challan No: To be Filled by Student

Please credit the amount towards Application Fee to the account of DIRECTORATE OF TECHNICAL EDUCATION Account No. 67179772330 with SBT, Fort Branch,Trivandrum - code - 481.

Application No 33087 Name of Degree: MTECH

Name of Student: SYAMPRASAD S

Amount: 500 Commission: 10

Name and Address of Student:Syam NivasKurampala south P.OPandalamPathanamthitta

Bank Seal

Cashier: Passing Officer:

Mobile Number: 9446935377

Amount in words: Five Hundred and Ten Only

Signature:.................................

Total: 510

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Student Copy

Date:............................

To be Filled by StudentBranch:Challan No:




Amount: 500 Commission: 10Name and Address of Student:

Syam Nivas Kurampala south P.O Pandalam Pathanamthitta

Bank Seal



Signature:.................................

Total: 510

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Orginal Copy

Date:............................

Branch:Challan No:

To be Filled by Student

To be submitted along with the Application _____________________________________




Amount: 500 Commission: 10Name and Address of Student:

Syam Nivas Kurampala south P.O Pandalam Pathanamthitta

Bank Seal



Signature:.................................

Total: 510510

33087

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