GOVERNMENT OF TAMIL NADU

DIRECTORATE OF TECHNICAL EDUCATION

TAMIL NADU ENGINEERING ADMISSIONS - 2024
Application for Admission to B.E/B.Tech Degree Course
Application Number: 235612

Personal Information
Name: HARSHITHA K Name of the Parent/Guardian: BHUVANESWARI R
Communication Address: NO 4/1A Permanent Address: NO 4/1A
VELSOMASUNDARAM NAGAR VELSOMASUNDARAM NAGAR
CHEYYAR CHEYYAR
State: Tamil nadu District: Tiruvannamalai
Taluk: Cheyyar Communication address pincode: 604407
Native District: Tiruvannamalai Civic status of Native Place: Municipality
Date of Birth (DD-MM-YYYY): 22-08-2006 Gender: Female
Mother Tongue: Tamil Nationality: Indian
Nativity: Tamil nadu Religion: Hindu
Name of the Community: BC Name of the Caste: Kaikolar, Sengunthar
Aadhar Number (optional): 593781880892

Special Reservation Information

Whether you are a candidate under quota for Eminent Sports person as per Ex-Servicemen (Only Army/Navy/ Air force services are Eligible): No
annexure-II, item No.22 of information brochure?:
No
Differently Abled Person: No Differently Abled Type: --
TFC Center for certificate verification:
Govt. Polytechnic College, Cheyyar, Thiruvannamalai – 606 705

Scholarship Information
Parent Occupation: Others Annual Income: 72000
Are you a First Graduate?: No Post Matric Scholarship (SC/SCA/ST/Converted Christians): No
Are you planning to avail education loan?: Y

School of Study Information

Category of School: Private Civic status of school location (+2): Municipality
Have you studied VIII to XII in Tamil Nadu?: Yes Have you studied from VI to VIII in private school under RTE and IX to XII
in Government School?:
No
Have you studied VI to XII in Government school?: No

Class Year of Passing Name of the school District State Block Category of
Govt.School

VI Std. 2018 indo american matric hr.sec.school Tiruvannamalai Tamil nadu Cheyyar --
cheyyar

VII Std. 2019 indo american matric hr.sec.school Tiruvannamalai Tamil nadu Cheyyar --
cheyyar

VIII Std. 2020 indo american matric hr.sec.school Tiruvannamalai Tamil nadu Cheyyar --
cheyyar

IX Std. 2021 indo american matric hr.sec.school Tiruvannamalai Tamil nadu Cheyyar --
cheyyar

X Std. 2022 indo american matric hr.sec.school Tiruvannamalai Tamil nadu Cheyyar --
cheyyar

XI Std. 2023 indo american matric hr.sec.school Tiruvannamalai Tamil nadu Cheyyar --
cheyyar

XII Std. 2024 indo american matric hr.sec.school Tiruvannamalai Tamil nadu Cheyyar --
cheyyar

Academic Information
Qualifying Examination: TN-HSC Name of the Board of Examination: Tamil nadu Board of Higher Secondary Education
Permanent register number: -- HSC Roll number: 6583242
Qualified Year: 2024 HSC Group: HSC Academic
Group Code: Physics/ Chemistry/ Maths/ Computer Science Medium of Instruction: English
HSC maximum (total) marks: -- HSC obtained marks: --
SSLC maximum (total) marks: 500 SSLC obtained marks: 468
Have you applied for NEET ?: No Have you applied for JEE ?: No
 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSIONS - 2024
Application for Admission to B.E/B.Tech Degree Course
Application Number: 235612

Have you applied for Indian Maritime University Common Entrance Test (IMU Educational Management Information System(EMIS) Number:
CET)?: 3306020752500024
No
Community certificate number: TN-5202404018769 Nativity certificate number (if applicable): TN-3202404014676
 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSIONS - 2024
Application for Admission to B.E/B.Tech Degree Course
Application Number: 235612

Affix recent Passport

size Photo

DECLARATION BY THE APPLICANT

I, HARSHITHA K (Son / Daughter) of BHUVANESWARI R hereby solemnly declare that the information furnished and the statements given
in the application and the enclosures are true, correct and complete. I further declare that should it be found otherwise, I will be liable to forfeit
my seat and / or removal from the rolls of the Institution at whatever stage of study I may be, besides making me liable for criminal prosecution.
I am fully aware that as per the directions of the Hon'ble Supreme Court of India and Tamil Nadu Prohibition of Ragging Act 1997, Ragging
is an offence, as is banned in the Institutions and anyone indulging in ragging is liable to be punished such as expulsion from the Institutions
and / or rigorous imprisonment up to 3 years, and / or fine up to Rs.25,000/-

Place:

Date: ( Signature of the Applicant )

DECLARATION BY THE PARENT/ GUARDIAN

I, BHUVANESWARI R (Parent / Guardian) of HARSHITHA K hereby solemnly declare that I am fully aware of the declaration made by the
applicant, and I declare and bind myself on the same terms contained in the above declaration. The statements and the information given are
true, correct and complete. If it is found otherwise, the applicant is liable to forfeit the seat and / or removal from the rolls of the Institution at
whatever may be the stage of study, besides making me liable for criminal prosecution I am fully aware that as per the directions of the Hon'ble
Supreme Court of India and Tamil Nadu Prohibition of Ragging Act 1997,Ragging is an offence, as is banned in the Institutions and anyone
indulging in ragging is liable to be punished such as expulsion from the Institution and / or rigorous imprisonment up to 3 years, and / or fine
up to RS. 25,000/-

Place:

Date: ( Signature of Parent / Guardian )

Note: Guardian can execute the above declaration, only if both the parents are not alive.
 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSIONS - 2024
Application for Admission to B.E/B.Tech Degree Course
Application Number: 235612

The following Certificates copy have to be uploaded to our system.

1. Transfer certificate
2. 10th Mark Sheet
3. 12th Mark Sheet
4. Permanent Community Certificate Card for BC (Permanent card / Electronic form / Digitally Signed E-Certificate)
5. Income Certificate of the Parent
6. Special Reservation Form for Sports and relevant certificates
7. Special Reservation Form for Ex-Serviceman and relevant certificates
8. Special Reservation Form for Blindness & Low Vision and relevant certificates