8/13/2021 CENTAC - Govt.

of Puducherry

CENTRALISED ADMISSION COMMITTEE

Government of Puducherry
APPLICATION FORM FOR ONLINE CENTAC ADMISSION - 2021 - 22

APPLICATION NUMBER : 52101193

Personal Data
Applicant's Name K.MOHAN RAJ

Father's Name K.KUMAR

Gender male

Date of Birth 18/11/2003

Religion Hindu

Mother Tounge Tamil

Address Details
Email mohanrajkmohan1@gmail.com

Mobile Number 9791567464

Permanent Address No.36 Second Street Bharathi Nagar Ariyur,605102

Communication Address Venkatesshwara Nagae Ariyur,605102

Alternate Mobile Number 6380405594

Aadhar Number 636037276907

Reservation Details
Nationality INDIAN

Residence Puducherry

Region/Taluk Pondicherry - Villianur

Category OBC Migrant No

NRI Sponser No Regional Reservation No

Special Reservation Details

Special Category - Rural -

Village Extention Worker No Ward of Farmer No

EWS No Minority -

Applied for SELF SUPPORTING seats in Biology based courses (Veterinary, Agriculture, No
Horticulture, B.Pharm., BPT, B.Sc. (Nursing/ MLT/ MRIT) / Engineering Courses

Academic Details
HSC Board Name Tamil Nadu

Stream Name Academic

Number of attempts 1

HSC Registration Number: 3822842

Class School Name Type Year of Passing

12th SRI SAMPOURNA DIDYALAYAM Private 2021

11th SRI SAMPOURNA DIDYALAYAM Private 2020

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8/13/2021 CENTAC - Govt. of Puducherry

10th SRI RAMACHANDRA VIDHYALAYA HIGH SCHOOL Private 2019

9th SRI RAMACHANDRA VIDHYALAYA HIGH SCHOOL Private 2018

8th SRI RAMACHANDRA VIDHYALAYA HIGH SCHOOL Private 2017

Applied courses Professional Courses

Marks
Subjects TAMIL ENGLISH PHYSICS CHEMISTRY COMPUTER MATHEMATICS
SCIENCE /
MATHEMATICS
I

Marks 82.56 / 100 77.9 / 100 75.2 / 100 82.34 / 100 82.05 / 100 75.9 / 100

Secured Mark / Maximum Mark 475.95 / 600

Payment Details
Reference Number 1628872074

Amount 0.00

Pay Date 2021-08-13 21:08:54

Attachments
Attached File Uploaded View

Birth Certificate YES Birth Certificate

HSC Marksheet YES HSC Marksheet

Tenth Marksheet YES Tenth Marksheet

Residence Certificate YES Residence Certificate

Community Certificate YES Community Certificate

Transfer Certificate YES Transfer Certificate

PROFESSIONAL COURSE PREFERENCE - First Round Last update: none

Your PROFESSIONAL Course Preference List is Empty Please Select Courses

Declaration
 I hereby declare that I have carefully read the Prospectus and the Non-Disclosure agreement. All the particulars stated in
this application form are true and correct to the best of my knowledge and belief. If any of these information provided is
found false/ incorrect, I shall abide by the actions and decisions taken by the CENTAC

Signature

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