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Application Number: 22UHSA173

JAMAL MOHAMED COLLEGE (Autonomous)

7, Race Course Road, TIRUCHIRAPPALLI - 620020. INDIA

APPLICATION FOR ADMISSION - (2022-2023)

Under Graduate - Aided

Course Choice 1: BA HISTORY

Course Choice 2: BA ENGLISH
For office use:
Admitted in: __________________________________________ on ________________

Language under part I *: Tamil Arabic French Hindi Urdu PRINCIPAL

Applicant's Name: ARUN SHANKAR PRAKASH S

Date of Birth : 30/01/2004 Nationality : IN

Place of Birth : TIRUCHIRAPPALLI Aadhar Card No. : 447617065798

Religion & : HINDU & Caste : AGAMUDAIYAR

Community

Blood Group : A1 +ve Mother Tongue : TAMIL

Mobile Number : 8428821474 Email Id : arunshankarprakash30@gmail.com

Distinction in Sports : - Extra Curricular : -

Activities / Co-
Curricular Activities

Whether Differently-Abled : -

Whether Son of Ex-Serviceman : -

Hostel Accommodation : -

PARTICULARS OF PREVIOUS ACADEMIC RECORD

School Last Studied : STLITTLE FLOWER MATRIC HR SEC SCHOOL

Address : KATTUR TRICHY-11

Qualifying Exam Passed : HSC

Register No. : 2016468826

Maximum Month & No. of

Subjects Mark Marks Year Attempts

TAMIL 97.89 100 May/2021 0

ENGLISH 97.22 100 May/2021 0
PHYSICS 95.57 100 May/2021 0

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Maximum Month & No. of

Subjects Mark Marks Year Attempts

CHEMISTRY 95.29 100 May/2021 0

COMPUTER SCIENCE 98.43 100 May/2021 0
MATHEMATICS 96.56 100 May/2021 0
Total Marks Secured 580.96 600 Percentage: 96.83 %

PARTICULARS OF THE PARENTS/GUARDIAN

Father's Name : SELVARAJ Occupation : ADVOCATE

Annual Income : 160000 Contact No. : 8428821474

Email Id : -

Mother's Name : SORNA Occupation : ADVOCATE

Annual Income : - Contact No. : 8270361650

Email Id : -

Guardian's Name : - Contact No. : -

Email Id : -

Address for Communication Permanent Address

NO:26,PANAKKAL STREET,M.K.KOTTAI,TRICHY-11 NO:26,PANAKKAL STREET,M.K.KOTTAI,TRICHY-11

TIRUCHIRAPPALLI TIRUCHIRAPPALLI

TAMILNADU TAMILNADU

Pincode: 620011 Pincode: 620011

Email: arunshankarprakash30@gmail.com Mobile: 8428821474

NOTE
1. Fill up the application form as per the data mentioned in your +2 Mark sheet & T.C.
2. Omission or withholding details required or giving incorrect information will result in summary rejection of
application or cancellation of admission.

Our College does not Collect Capitation Fee for Admission to Any course

DECLARATION
* I declare that the particulars given here are correct and I will, if admitted, abide by the rules and regulations of
the College. I assure
that I will not take part in political or agitational activities inside or outside the College and I
further promise that I will
behave in a manner that will bring credit to the College and to our Country
* I am aware of the law regarding the prohibition of ragging as well as the punishments and if found guilty of the
offence of
ragging and / or abetting ragging, is liable to be punished appropriately. I agree to abide by the
punishment in case I am found
guilty of ragging and / or abetting ragging.
Date: 01-Jul-2022
Station: Signature of the Parent/Guardian Signature of the Applicant
Name:

FOR OFFICE USE ONLY

Signature of Staff Who Processed the Application: ___________________

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Date of Payment:

Bill Number:

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