University of Madras

Application to the Post Graduate / Post Graduate (Five Year Integrated Course) /M.Phil. / P.G.Diploma/ Diploma/
Certificate programmes offered in the University Departments under Choice Based Credit System (CBCS) for the
Academic year 2017-2018.

Application No.: 1706725 Name : SADHASIVAM S

Admission for : M.Sc. Programme

Department / branch Organic Chemistry
:

Name (Tamil) : Religion : Hindu Category: BC

Gender Male Parents annual income :
Date of birth : 27/07/1997 Blood Group: AB+
Native state : Tamil Nadu
Father's Name: sivasankar Mother's Name: narayani
Address for Communication : Permanent address :
143/27 big street tiruvannamalai 143/27 big street tiruvannamalai

606601 606601
Mobile : 9043966195 Aadhaar: 425469869647 E-Mail : sadhasivam1996@gmail.com

A person of :

Number of years of study (school and college) : 11+1+3 = 15 Years Payment details:
Qualifying examinaton passed : Online payment Ref.No. : DU67463870
Qualification :UG Transaction Date : 09/06/2017
Subject :gendral chemestry
Reg. no. :20414u17069
Semaster :Pre-Final Semester - Month & year of pass :5 semester
Average Percentage of Core Subjects Marks:70
Average Percentage of Allied \ elective Subjects Marks:68
Average Percentage of (Core + [Allied \ elective]) Subjects Marks:71

Attach copy of the following certificates/documents :

Note:
Marks obtained in language, non-major electives,
Practicals, Project, Internship and soft skills should not
be considered while computing the above percentage of
marks for the qualifying degree

DECLARATION BY THE APPLICANT

I hereby declare that the particulars furnished above are correct. I agree that the authorities may invalidate my application, at any time, if
any of the information furnished is found to be false. I am aware that my eligibility for admission to a programme will be decided by the concerned
admitting authority and I will abide by the CBCS Rules and Regulations of the University.

Date: 09/06/2017
Signature