APPLICATION FORMAT FOR ADMISSION TO THE COACHING FOR

CSAT 2014 COACHING PROGRAMME

1. Name (in BLOCK CAPITALS) : T. PHANI SHARAVAN
2. Fathers Name : T. VARAHALU RAO
3. Sex : Male
4. Community : SC
(SC / ST / BC / Minority)
5. Native Place & District : Visakhapatnam, Visakhapatnam District
6. Date of Birth & Age in completed : 09.12.1990, 22 Years and 5 Months
Years
(copy of SSC marks memo should
be enclosed)
7. Educational Qualification : M.A. Economics(5-year Integrated Masters Program)
(Copy of Provisional / Degree Indian Institute of Technology, Madras
Certificate of qualifying exam
should be enclosed)
8. Annual Income of Father / Guardian :
(Copy of Income Certificate issued by
concerned MRO for the year 2012-13
to be enclosed).
9. Place at which you wish to appear : VISAKHAPATNAM
for A.P. Study Circle Exam

10. * Mobile No. : 09445422098
11. * Email I.D. : phanisharavan@gmail.com
(Furnishing Mobile No. and email I.D. is mandatory)
12. Complete Address for Correspondence :
DECLARATION
I certify that the facts mentioned above are true and correct and I shall forfeit candidature
if any information furnished is found to be incorrect.
Place : Visakhapatnam
Date : 05.06.2013 Signature of the Candidate.
HALL TICKET
FOR ADMISSION TO ENTRANCE TEST FOR CSAT-2014 EXAMINATION
(To be filled in by the candidate)
1. Name : T.Phani Sharavan
2. Fathers name : T.Varahalu Rao
Signature of the candidate
(For Office Use)
Venue : Hall Ticket No. :
Date of Exam : 23-06-2013
Time of Exam : 11.00 AM to 01.00 PM
Signature of the Convenor.
(PS Hall Tickets in duplicate should be filled in and sent along with the application).


Paste passport
Size Photograph
here

Paste passport
Size Photograph
here