HARITHA OVERSEAS EDUCATION

CONSULTANTS LLP
APPLICATION FORM

FIRST NAME (As per the Passport) : AJITHKUMAR SURNAME (As per the Passport) : ELANGOVAN

PASSPORT NO : V2052894 VALID FROM: 19/07/2021

VALID TO: 18/07/2031

GRE REG NO : TOEFL/IELTS REG NO :

TEST DATE : TEST DATE :
VERBAL : QUANTS : AWA : TOTAL : L: S: R: W: O:
ESTIMATED DATE (If not taken) : ESTIMATED DATE (If not taken) :
ESTIMATED SCORE : ESTIMATED SCORE :

10TH - 12TH -
PERCENTAGE : 79% PERCENTAGE : 83%
SCHOOL : ANNAI TERESA MATRICULATION SCHOOL : FATIMA MATRIC & HIGH SEC SCHOOL
SCHOOL FROM : 2020 TO : 2021
FROM : 2018 TO : 2019
UG – PG –
PERCENTAGE/CGPA : PERCENTAGE/CGPA :
COLLEGE/UNIVERSITY : COLLEGE/UNIVERSITY :
UG MAJOR : PG MAJOR :
FROM : TO : FROM : TO :

WORK EXPERIENCE : D.O.B (As per the passport - 03/06/2003)

COMPANY NAME : PLACE OF BIRTH : JAYANKONDAM
DESIGNATION : MOBILE : 7305438726
FROM : EMAIL ID : ajithkumarelangovan21@gmail.com
TO :

ADDRESS : FATHER’S FIRST NAME : Elangovan

FATHER’S LAST NAME : Chandrahasan
STREET-1: 6/2, North street, Anaikudam MOBILE : 7094866245
STREET-2 : Ariyalur (dt), 612902 EMAIL : elangovananjalai@gmail.com
CITY : Jayankondam
STATE : Tamil Nadu MOTHER’S FIRST NAME : Anjalai
COUNTRY : India MOTHER’S LAST NAME : Elangovan
PINCODE : 612902 MOBILE : 6369797260
EMAIL : atchue101@gmail.com
 INTENDED MAJOR : BS Computer Science SPECIALIZATION (If Any) :

RECOMMENDERS DETAILS : FINALIZED UNIVERSITIES WITH COURSE :

REFEREE 1 :
NAME – 1. ARIZONA STATE UNIVERSITY B.S. in Computer
DESIGNATION – Science
EMAIL – 2. University of North Texas B.S. in Computer
MOBILE – Science
ADDRESS – 3. University of Albany, The State University of
New York, Albany (SUNY Albany)
REFEREE 2 : B.S. in Computer Science
NAME – 4. Washington State University
DESIGNATION – B.S. in Computer Science
EMAIL – 5. New York Institute of Technology
MOBILE – B.S. in Computer Science
ADDRESS –
6.
REFEREE 3 :
NAME – 7.
DESIGNATION –
EMAIL – 8.
MOBILE –
ADDRESS – 9.

10.

NOTE : Please make sure that all the information you are providing in the form are accurate
as per your Passport and educational documents.

I hereby confirm that all the information provided in this form is checked and finalized by me.

Regards,