KHADIR MOHIDEEN COLLEGE

[CO-EDUCATION]
[NATIONALY RE-ACCREDITED WITH B GRADE BY NAAC]
[AFFILIATED TO BHARATHIDASAN UNIVERSITY, TRICHY]
ADIRAMPATTINAM-614 701, THANJAVUR(Dt)

APPLICATION FORM FOR ADMISSION

UNAIDED COURSES(UG)
Degree:B.C.A Application No: OLSF-00007
Major:Computer Applications Registration No:
Paid ID: MOJO1716205D59582716
Paid Amount:
107.08

1. Name: Abinesh.L

2. Date of Birth: 05/03/2004

3. Father's Name: Loganathan

4. Father's Occupation: Farmer

5. Mother's Name: Malathi

6. Mother's Occupation: Home maker

7. Gender: Male

8. Place of Birth: Muthupet

9. Contact Number(Mobile): 9025054379

10. Nationality: Indian

11. Religion: Hindu

12. Community: MBC/DNC

13. Caste: Ambalakarar

14. Annual Income: 60000

15. Aadhar Number: 658249892195

16. Bank Account Details: 6680908569, Indian bank, muthupet

17. Permanent Address: 125-4/64,

North kadu,
Alangadu,
Thiruvarur,
Tamil nadu

18. Whether Hostel Required(Girls Only): No

19. Name of the Local Guardian(for hosteler):

20. Physically Challenged? : No Details(if yes) :

21. Son/Daughter of Ex.serviceman of Tamilnadu Origin? : No

Troupe No. & Rank (if yes) :
22. Tamil Origin from Andaman and Nicobar Islands ? : No
 23. Name & Address of the Institution last studied:
24. Qualifying Examination Passed
specify the University/Board : Tamilnadu State Board

25. Details of Marks in the Main / Core Subjects for Degree Course

Sl Subject Marks Obt. Max Marks Month & Year of Passing Register No No. of Attempts
1 Tamil 100
2 English 100
3 100
4 100
5 100
6 100
7 Total 600

26. Distinction in Sports/NCC/NSS/Other Extra-Curricular activities

Sl Activities Level of Participation Awards/Commendations
1 Sports District level

I declare that the particulars furnished above are true and correct.
I submit that I will abide by the rules and regulations of the College.
Place:
Date :16/07/2021 Signature of the Student

FOR OFFICE USE ONLY

Received and Registered on :__________________________________________________________________

Interview Date :_______________________________ Fees Paid :_____________________________

Certificates Verified

 HSC MARKSHEETS  COMMUNITY CERTIFICATE

 TRANSFER CERTIFICATE  CONDUCT CERTIFICATE

 SPECIAL CATEGORY CERTIFICATE  ELIGIBLITY CERTIFICATE

Signature of the Staff who processed the Applicaiton:

NOT ADMITTED PROVISIONALLY ADMITTED ADMITTED

PRINCIPAL