Application Sequence

Application
BTMTI1514198
31/05/2015
Number:
Date:
Name of
Email
the
VENKATESH BHARADWAJ.S
seeni1967@gmail.com
Address:
Applicant:
Gender: M
Nationality: Indian
Date of
07/10/1997
Religion: Hindu
Birth:
Father's
Community
SRINI VASAN.N
OC
Name:
:
Mother's
MAHA LAKSHMI.G
Caste:
Brahmin
Name:
3/51,Antona Flats, Ayyavoo street, Shenoy Nagar Chennai Chennai Tamil
Address :
Nadu India PinCode: 600030
Father's Occupation Details
Name of
Occupation: Govt Service
TNEB
Organization:
Asst. Executive
Annual
Designation:
600000
Engineer
Income:
seeni1967@gmail.co
Email:
Mobile No: 9445857657
m
Phone No.
044-26640509
(Resi):
Course
Payment
Details
Details
Campus
Payment
Main Campus Thanjavur
online
Selected:
Mode:
Course B.Tech/M.Tech. (5 Yrs
Selected: Integrated)
Branch B.Tech - Computer Science &
Choice 1: Engineering
Branch B.Tech - Electronics &
Choice 2: Communication Engineering
Branch
B.Tech - Mechanical Engineering
Choice 3:
Qualification Details
Qualifying Exam : 10+2
Mon Year Name
Mark
School/C
School/C School/C
Max
th of of
of
School/Colle
Registra
s
ollege
ollege
ollege
Mar
Passi Passi Board/
ge Address
tion No
obtai
Name
District
State
ks
ng ng Univ
ned
Tamilna
du State
Board 10t
April 2013 with
h
Tamil
Langua
ge

HOLY
CROSS
MATRIC.
HIGHER
SECOND
ARY
SCHOOL

KAMARAJ
NAGAR
COLONY
Tamil
P.O. ,
Nadu
AMMAPET,S
ALEM

Tamil
Nadu

1498718 500 485

Central MAHARI
Board SHI
of
VIDYA
DR.GURUSA
12t Marc
Seconda MANDIR
Tamil
2015
MY ROAD,
h h
ry
SENIOR
Nadu
CHETPET
Educati SECOND
on
ARY
(CBSE) SCHOOL

Tamil
Nadu

4603099 500 478

JEE Roll No

Marks Scored

Maximum Marks

29301131

171

360

Declaration
I hereby solemnly and sincerely affirm that the statement made and the information furnished
by me in the application as also in enclosures thereto submitted by me are true. Should it,
however, be found that any information furnished therein is untrue in material particulars or
on verification at a later stage, I am liable for criminal prosecution and I also agree to fore go
my seat in this Institution / for the removal of my name from the rolls of the institution at
whatever stage of study I may be at the time of detection of such wrong particulars. I am also
fully aware of the general instructions and I am bound by the same.
Date ...........................
Place ...........................
Signature of the Candidate ..........................
I am fully aware of the above declaration and I have understood the same. I agree to the
above conditions.
Place ...........................
Date ...........................
the Parent/Guardian ..........................

Signature of