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Graduate Programme Admission Application Form

APPLICATION DETAILS Application Number Course Preference Faculty Department Programme Name Academic Year Semester Specialisation Finance PERSONAL PARTICULARS Title Given Name Surname/Family Name Full Name Gender Marital Status Date of Birth ID Number (NRIC/FIN/UID) Passport/NRIC Place of Issue Passport Number Passport Date of Issue Passport Expiry Date Citizenship Place of Birth Race Country of Residence CONTACT Personal
SRI LANKA SRI LANKA INDIAN SINGAPORE MR Sarangan Karunamoorthy Karunamoorthy Sarangan Male SINGLE 12/02/1984 G5224984N SINGAPORE N3270106 27/08/2012 2013053263 Part Time 1 School of Computing Dean's Office (School Of Computing) Master of Computing (MComp by Coursework) 2013/2014 1 Infocomm Security-SPN SELF SUPPORT

Application No.: 2013053263

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Email Alternate Email HandPhone Telephone Address Postal Code Country Next of Kin Title Name Relation Email Alternate Email HandPhone Telephone Address Postal Code Country Mailing Email Alternate Email HandPhone Telephone Address Postal Code Country LANGUAGES

sarangan12@gmail.com sara@incent.com.sg 65-9-0213652

BLK 13 Marsiling lane #05-17 730013 SINGAPORE

MR Karunamoorthy FATHER sara@vista.aero sara@vista.aero

94-21-2227068 405,Temple Road Nallur Jaffna

SRI LANKA

sarangan12@gmail.com

65-9-0213652

BLK 13 Marsiling lane #05-17 730013 SINGAPORE

No Record(s) found

ACADEMIC QUALIFICATIONS Academic History 1 Category Qualification Qualification (others) Qualification Type Area of Specialisation If other Specialisation, please specify. Application No.: 2013053263 Page 2 of 6
Dist Software Engineering DIPLOMA AdvDip in Computing

Location of Institute Name of Institute Name of Institute (Others) CGPA/CAP/Average Mark Best/Maximum Possible Score Course Type From Date To Date Completed Degree/Programme Is this course subsidized by Singapore Government or sponsored by any Singapore Government Agency? Please specify the Government Agency that provided the Sponsorship / Subsidy. How many months is the course being subsidized/sponsored? Certificate Received Date Expected Complete Date Academic Rank/Position Programme Level Duration of Programme (in months) Academic History 2 Category Qualification Qualification (others) Qualification Type Area of Specialisation If other Specialisation, please specify. Location of Institute Name of Institute Name of Institute (Others) CGPA/CAP/Average Mark Best/Maximum Possible Score Application No.: 2013053263

SRI LANKA

Institute of Informatics Studies

Full Time 24/04/2005 24/04/2006 Completed No

24/04/2006

20

1ST BACHELOR'S DEGREE Bachelor of Computer Sci(Hons)

1st Class Computer Science

MALAYSIA

Binary University College 3.84

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Course Type From Date To Date Completed Degree/Programme Is this course subsidized by Singapore Government or sponsored by any Singapore Government Agency? Please specify the Government Agency that provided the Sponsorship / Subsidy. How many months is the course being subsidized/sponsored? Certificate Received Date Expected Complete Date Academic Rank/Position Programme Level Duration of Programme (in months) EMPLOYMENT HISTORY Employment History 1 Designation Occupation Name of Company Industry Sector Date Employed (From) Date Employed (To) Nature of Organisation Country of Employment Type of Employment No. of people reporting to you Job Responsibilities

Full Time 01/07/2007 31/08/2009 Completed No

20/09/2010

Secondary 18

Software Developer IT PROFESSIONALS Incent Pvt.Ltd INFORMATION TECHNOLOGY AND TELECOMMUNICATIONS 28/11/2011

PRIVATE SECTOR SINGAPORE Full Time

Working on Mobile Marketing system integrating with sms gateway in php. Process soap requests in python, php to integrate Norwegian schools. Create RESTFUL services for Mobile applications. Create mobile,web application in HTML5/Sencha-touch framework.

OTHER ACHIEVEMENTS Achievement 1 Award Type Application No.: 2013053263

Award

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Name of Awarding Institute Details From Date To Date Achievement 2 Award Type Name of Awarding Institute Details From Date To Date TEST DETAILS

Binary University College Deans Award 01/07/2010

Award Binary University College Chancellors Overall Best Student Award 01/07/2010

No Record(s) found

QUESTIONNAIRE
No Record(s) found

OTHER INFORMATION Disabilities & Special Needs

1) Have you had or do you have any communicable disease, mental illness, colour blindness, and/or disability (including but not limited to chronic illness, visual or other physical constraints or limitations), which may or may not cause you to require special assistance or facilities while studying at the university? No 2) If 'YES', please provide all relevant information below. This information will allow the University to develop a complete profile of an applicant and to determine whether he/she might need additional resources in his/her studies. The university, however, does not guarantee the provision of special aid (financial or otherwise) to any students. 3) Any Other Information?

REFEREES No.
1 2

Name
Rohini Devi Sham Shul Mat

Email
rohinids@binary.edu.my matsham@gmail.com

Telephone
60-03-80706590 60-03-80706590

Organisation
Binary University Binary University

DECLARATION No.
1

Question
Have you ever been convicted of any offence by a court of law in any country or are there any court proceedings pending against you anywhere in respect of any offence? Are you currently, or have you ever been, charged with or subject to disciplinary action for any type of misconduct, scholastic or otherwise, at any educational institution?

Answer
No

Comments

No

Application No.: 2013053263

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Are you currently or have you ever been under investigation or subject to enquiry in respect of any misconduct, scholastic or otherwise at any educational institution?

No

I declare that the information provided by me in connection with this application is true and complete. I understand that any inaccurate, incomplete or false information given or omission of material information required shall render this application invalid and NUS may at its discretion withdraw any offer of admission made to me on the basis of such information or, if already admitted, I may be liable to disciplinary action, which may result in my expulsion from NUS. I understand that the provision of any inaccurate or false information may render me liable to prosecution in a court of law in Singapore. I understand that if I have been convicted of a criminal offence by a court of law of any country, I must submit all relevant information together with this application. I hereby authorized NUS to obtain and verify any part of the information given by me from or with any source, as deems it appropriate.

_________________________________ Name and Signature of applicant

_________________________________ Date and Time

Application No.: 2013053263

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