GOVERNMENT OF KERALA

DEPARTMENT OF TECHNICAL EDUCATION

Application to Polytechnic College Admission 2010-11
Application No.: 170007
Page : 1 of 3
Date of online entry: 21/05/2010
Fee to be remitted: Rs. 100/- x 3 = Rs. 300/-

Districts chosen for Admission

Name of the District where the candidate
1) Thiruvananthapuram 2) Ernakulam 3) Thrissur
seeks admission:

Basic Details
1. Name of the Candidate: VINAY SANKAR
2. Name of Father/Mother/ K.M. SANKARANKUTTY 3. Relationship with Applicant: Father
Guardian
4. Communication Address:
VINAY SANKAR
TC- 19/2150,KARTHIKA
MUDAVANMUGAL
POOJAPURA P.O.
TRIVANDRUM - 12

PIN CODE: 695012

5. Mobile No.: 9061594680 6. E-mail: VINAYSANKAR91@GMAIL.COM

7. Gender: Male 8. Date of Birth: 24/12/1991
9.Nationality: Indian 10. Native District: Thrissur
11.Annual Family Income: 316716

Community Details
1.Are you eligible for No 2.Community Ezhava
reservation under
inter-caste married
2.Whether OEC: No

Other Reservation Details

1.Have you passed ITI No 2.ITI Trade:
examination:
3.Have you passed VHSE: No 4.VHSE Trade:
5.Are you a person with No
disability:
6.Special Reservations: No

Academic Details
1.Name of Examination: CBSE 2.No. of Subjects: 5
3.Year of Passing: 2008 4.Exam Register No.: M/08/06654/1507
5.No. of Chances Taken: 1
 Application No.: 170007
Page : 2 of 3
6.Mark List

Sl. No. Subject Name Max. Marks Marks

1 ENGLISH 100 64
2 LANG 100 75
3 MATHS 100 76
4 SCIENCE 100 74
5 SOCIAL 100 65

Option Details
Option No. Polytechnic College Course Name

District: Thiruvananthapuram
1 Central Polytechnic College, Thiruvananthapuram Civil Engineering
2 Central Polytechnic College, Thiruvananthapuram Mechanical Engineering
District: Ernakulam
1 Government Polytechnic College, Kalamassery Civil Engineering
2 Government Polytechnic College, Kalamassery Mechanical Engineering
District: Thrissur
1 Maharaja's Technological Institute, Thrissur Civil Engineering
2 Maharaja's Technological Institute, Thrissur Mechanical Engineering

Certificate Details
Sl No. Name of Certificate Issue Date Authority

1 SSLC/THSLC or equivalent Certificate 27/05/08 CBSE

2 Community Certificate from Village Officer. 20/05/10 VILLAGE OFFICE
3 Income Certificate from Village Officer. 20/05/10 VILLAGE OFFICE

Declaration
1. I hereby declare that, I have read the various clauses in the Prospectus for Admission to Polytechnic Colleges 2010 - 2011
and the instructions carefully and I agree to abide by them.

2. I also declare that all the statements made in this application are true, complete and correct to the best of my knowledge
and belief and that in the event of any information being found false or incorrect or ineligibility being detected before or
after the admission, action can be taken against me.

Signature of the Parent/Guardian Signature of the Applicant

Place:
Date:
 Application No.: 170007
Page : 3 of 3

Receipt

Received from VINAY SANKAR, S/D/W/o Sri. K.M. SANKARANKUTTY,

application for Polytechnic Admission (Application No. 170007) on ........................ at ...............................................................
Polytechnic College,............................................. an amount of Rs. Rs. 100/- x 3 = Rs. 300/- is received as the application fee.
The Application is registered with Registration No................

Seal of Receiving Polytechnic College Principal

Receipt

Received from VINAY SANKAR, S/D/W/o Sri. K.M. SANKARANKUTTY,

application for Polytechnic Admission (Application No. 170007) on ........................ at ...............................................................
Polytechnic College,............................................. an amount of Rs. Rs. 100/- x 3 = Rs. 300/- is received as the application fee.
The Application is registered with Registration No................

Seal of Receiving Polytechnic College Principal