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Application No: 33087

Government of Kerala
DEPARTMENT OF TECHNICAL EDUCATION

APPLICATION FOR ADMISSION TO

M.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
Affix recent

Pandalam

recent

Pathanamthitta

passport size
photo
3 (a) Contact Telephone Number
STD Code

4. Date of birth in Christian Era

Land Phone

Day
1

Mobile No 9 4 4 6 9 3 5 3 7 7
5

Sex

Month
9

E-mail ID

Is Keralite

Year

syamprasad.rbs@gmail.com

Religion

Caste

Reservation Category

Non-Creamy
Layer

Yes

Hindu

Vilakkithala Nair

SEBC - Socially and

Yes

Educationally
Backward Classes
6

Details of GATE Examination passed

Year

Reg.No.

Score

Mark

2016

CE16S51077150

362.00

26.13

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

Fee Amount

500

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Whether Physically Challenged

No

10 Sponsored Candidate

No

11 Choice of specialisation in the order of preference

Choice

College

Specialisation

Category

TKM College of Engineering, Kollam

Structural Engineering &

GATE

MA College of Engineering,

Structural Engineering &

Kothamangalam

Construction Management

College of Engineering,

Structural Engineering

GATE

Structural Engineering

GATE

Government College of Engineering,

Computer Aided Structural

GATE

Kannur

Engineering

Construction Management
GATE

Thiruvananthapuram
4

NSS College of Engineering,

Palakkad

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

Branch:
Challan No:

Bank Copy

To be Filled by Student
Date:............................
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 Student:

SYAMPRASAD S

Amount:

Name of Degree:

Commission:

500

10

Name and Address of Student:

Syam Nivas
Kurampala south P.O
Pandalam
Pathanamthitta

MTECH

Total:

510

Bank Seal

Mobile Number: 9446935377

Amount in words: Five Hundred and Ten Only
Signature:................................. Cashier:

Passing Officer:

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

Branch:
Challan No:

To be Filled by Student

Student Copy

Date:............................
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 Student:

Name of Degree:

SYAMPRASAD S

Amount:

500
Name and Address of Student:
Syam Nivas
Kurampala south P.O
Pandalam
Pathanamthitta

Commission:

10

MTECH
Total:

510

Bank Seal

Mobile Number: 9446935377

Signature:................................. Cashier:

Passing Officer:

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Orginal Copy

Branch:
Challan No:

To be Filled by Student

To
be submitted along with the Application
_____________________________________

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

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:

Name of Student:

SYAMPRASAD S

Amount:

Commission:

500
Name and Address of Student:

10

Syam Nivas
Kurampala south P.O
Pandalam
Pathanamthitta

MTECH
Total:

510

Bank Seal

Mobile Number: 9446935377

Signature:................................. Cashier:

Passing Officer: