App Form No 22B201215 Course Reg No 22BBBA156203

Mobile No 7604884726 CutOff out of 400 289.33

D. Roll No P. Roll No
(For Office Use Only)

(Autonomous)
Civil Aerodrome Post, Coimbatore, TamilNadu - 641014
Phone: 0422-4303300 E-mail: admission2022@psgcas.ac.in Web: www.psgcas.ac.in

Application form for admission to B.A. / B.Sc. / B. Com. / BBA / BCA / B.Voc / M.Sc. Software System Courses
(Self Financing Courses)

Course BBA

10th Register 20135011

Number

Full Name SURYA J

Gender MALE DOB (DD/MM/YYYY) 18/05/2004

Aadhar No 714113003925

Community Certificate

Community BC-OTHERS Sub Caste Name Kongu Vellalars

Issued by Tamil Nadu Government Issuing Authority ZONAL DEPUTY TAHSILDAR

Issued Place SULUR Issued Date 02/02/2008

Number 6657585 Religion HINDUISM

Contact Information

Father's Name JAYAKUMAR G Father's Mobile No 98422 40568

Father's BUSINESS Father's Annual Income 1000000

Occupation

Mother's Name POONGODI J Mother's Mobile No 98422 29989

Mother's OTHERS Mother's Annual 300000

Occupation Income

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Address M189 sihs colony

Name of City (or) COIMBATORE Nativity Urban

Village

District COIMBATORE State TN

Country INDIA Pincode 641014

Mobile 7604884726

E-mail suryajps52@gmail.com

Special Categories

Are you a Sportsperson? NO

Are you a NCC cadet? NO

Are you a ward/wife/widow of an Ex-Service person? NO

Are you Differently Abled / Physically Challenged? NO

Academic Information

Board CBSE Year of first appearance for 2021

12th Exam

Nature of Course ACADEMIC First Graduate Yes

Month / Year of
Subject Marks Secured Marks Out Of Register No No. of Attempts
Passing
NA

ENGLISH 72 100 05/2022 20661144 1

Part - III Subjects

ACCOUNTANCY 72 100 05/2022 20661144 1

BUSINESS STUDIES 78 100 05/2022 20661144 1

ECONOMICS 67 100 05/2022 20661144 1

NA

Total 433.33 600 Part III Total marks out of 400 289.33
Percentage 72.22 100 400

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 12th/Diploma Register Number 20661144

Name Address of the School Name NATIONAL MODEL SENIOR SECONDARY SCHOOL CBSE
School last Studied

District COIMBATORE

Place PEELAMEDU

DECLARATION
I declare that all the particulars furnished above are true and correct. I submit that I will abide by the rules and regulations of
the college if admitted.
Note - Attested copies of Mark Sheet and Community Certificate only to be enclosed with the application

Place: Coimbatore
Date: 22/07/2022 02:44 PM
Signature of the Parent / Guardian Signature of the Applicant

FOR OFFICE USE ONLY

Data Entered by Data Verified by

Certificate Verified

10th Marksheet Transfer Certificate Equivalence Certificate

11th Marksheet Community Certificate Special Category
Certificate
12th Marksheet Migration Certificate Name & Signature of staff who Signature of Principal
processed this Application

Certificates Verified by Admission Date

***** Please do not send the application via post *****

Printed on 22/07/2022 02:44:51 pm

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