B.

TECH APPLICATION FORM 2023 (PHASE-1)

APPLICATION NO : 23011012322

Program And Campus Preference

Campus SRMIST, Ramapuram Program Computer Science And Specialization
Big Data Analytics
Preference 1 Campus Preference 1 Engineering Preference 1
Campus SRMIST, Ramapuram Program Computer Science And Specialization
Cyber Security
Preference 2 Campus Preference 2 Engineering Preference 2
Artificial
Campus SRMIST, Ramapuram Program Computer Science And Specialization
Intelligence And
Preference 3 Campus Preference 3 Engineering Preference 3
Machine Learning

Personal Details
Nationality Indian
Have You Studied From India? Yes
Student Aadhar No. 864747313952
Full Name (As Per The Qualifying Examination Certificate) MONISH U
Mobile No. +91-9677197435
WhatsApp Mobile Number +91-9677197435
Email ID monishu224@gmail.com
Alternate Email ID subbaiahuv05@gmail.com
Date Of Birth 14/06/2005
Gender Male

Family Details
Parent Details : Father
Father Mother Guardian
Title Mr
Name U VENKATA SUBBAIAH
Mobile Number +91-9444466303
Email Address subbaiahuv05@gmail.com

Address Details
C Block 106 Rajangkuppam road,
Address Pin Code : 600095
Ayanambakkam
Country Name : India State : Tamil Nadu District : Chennai City: Chennai

Academic Details
Current Education Qualification Status : 12th Appearing
XII Details : X Details :
Institute Name VELAMMAL VIDYALAYA VELAMMAL VIDYALAYA
Board Central Board Of Secondary Education (CBSE) Central Board Of Secondary Education (CBSE)
Mode of Study Regular Regular
Marking Scheme Percentage
Percentage / CGPA 83.4
Year Of Passing 2021
Hall ticket No./Registration No. 20150543
Address Of School/College MEL AYANAMBAKKAM -
NAD ID/Digilocker ID -
Payment Details
Transaction ID 112765722849
Payment Date 12/01/2023
Mode Of Payment

Declaration
I Certify That The Information Submitted By Me In Support Of This Application, Is True To The Best Of My Knowledge And Belief. I Understand
That In The Event Of Any Information Being Found False Or Incorrect, My Admission Is Liable To Be Rejected / Cancelled At Any Stage Of The
Program. I Undertake To Abide By The Disciplinary Rules And Regulations Of The Institute.

Applicant Name : Monish U

Parent Name : U VENKATA SUBBAIAH

Date : 12/01/2023