APPLICATION FOR PG PROGRAMME(2022-23)

Programme Applied : Master of Arts in English Language and Literature

Regional Centre: Pattambi Regional Centre

Learning Centre : Sri. C Achutha Menon Government College, Kuttanellur

Full Name (as on Application

NIVEDITHA K S 20220104837
10th/aadhar) Number

Email nivedithaks33@gmail.com

10 digit Indian Mobile no. 8590185437

Alternate Mobile no. 8086316551

Relationship
Parent / Guardian Name SUDHEESH K T Father
with Applicant
Date of Birth
Gender Female 12/02/2002
(dd/mm/yyyy)
Marital Status Unmarried Religion Hindu
Caste Ezhava Category OBC
Employment
Differently Abled No Unemployed
Status
Communication Address Permanent Address
KALLENKUNNEL HOUSE,
KALLENKUNNEL HOUSE, VATTAKOTTAI, MUTTITHADI
VATTAKOTTAI, MUTTITHADI PO Pin:
PO Pin: 680317
680317
State Kerala District Thrissur

QUALIFICATION DETAILS
Qualification &
Year & month of Passing Institution Percentage
Specialization
Tenth Level GOVT OF
2017 89
STATE SYLLABUS KERALA
Higher Secondary/ +2 2019 HSE, KERALA 84
HUMANITIES
Degree
CALICUT
BA ENGLISH LANGUAGE 2022 63.58
UNIVERSITY
AND LITERATURE

IDENTIFICATION DETAILS
ID proof
ID Proof Type Voters id TQL8486540
Number

DOCUMENTS UPLOADED
PHOTO SIGNATURE OTHER DOCUMENTS UPLOADED

Tenth Level Certificate

Higher Secondary/ +2 Certificate
Degree Certificate
Identity Related Document
Transfer certificate

COUNSELLING SLOT BOOKING DETAILS

Date 18-11-2022 Time Slot 11:00 AM - 12 AM
Address of Counselling SreeNeelakanda Govt.Sanskrit College, Cherpulassery Rd, Mele
Centre: Pattambi, Kerala 679306
Phone No. 04662912009 email: rcpdirector@sgou.ac.in

FEE PAYMENT STATUS

Payment status : Paid Paid Amount : 4570.00 Transaction ID :

DECLARATION BY APPLICANT
I hereby declare that all the particulars given above are correct and I agree to abide by all the
Rules and Regulations of the University that are in force from time to time.
Station:

Date:
Signature of Applicant

FOR OFFICE USE ONLY

1. The particulars furnished in the application have been duly verified with Originals and the
Candidate is eligible for admission
2. Admission / Cancellation Intimation given / sent on ........................................................
3. Certificates returned to the Candidate on ......................................................................
1. S.S.L.C Statement of Marks
2. HSC Statement of Marks /Diploma Statement of Marks
3. UG Statement of Marks / Provisional/ Degree
4. Transfer Certificate

Verified By RC Director