GOVERNMENT OF TAMIL NADU

DIRECTORATE OF TECHNICAL EDUCATION

TAMIL NADU ENGINEERING ADMISSION - 2023
Application for Admission to B.E/B.Tech Degree Course
Application Number: 236201

Personal Information
Name: RAGUL R Name of the Parent/Guardian: RAMASAMY R
Communication Address: Permanent Address:
178, east street , silambur post, ariyalur district , andimadam taluk , 608901 178, east street , silambur post, ariyalur district , andimadam taluk , 608901
State: Tamil nadu District: Ariyalur
Taluk: Andimadam Communication address pincode: 608901
Native District: Ariyalur Civic status of Native Place: Municipality
Date of Birth (DD-MM-YYYY): 01-05-2006 Gender: Male
Mother Tongue: Tamil Nationality: Indian
Nativity: Tamil nadu Religion: Hindu
Name of the Community: MBC & DNC Name of the Caste:
Vanniakula Kshatriya (including Vanniyar, Vanniya, Vannia Gounder, Gounder or Kander, Pa-
dayachi, Palli and Agnikula Kshatriya)
Aadhar Number (optional): 327827758849

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:
University College Of Engineering, Ariyalur, Kathankudikadu Village, Thelur Post, Ariyalur -
621704

Scholarship Information
Parent Occupation: Agriculture Annual Income: 48000
Are you a First Graduate?: No Post Matric Scholarship (SC/SCA/ST/Converted Christians): No

School of Study Information

Category of School: State Govt Civic status of school location (+2): Town Panchayat
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. 2017 st mary's matriculation high school- Ariyalur Tamil nadu Andimadam --
kavarapalayam

VII Std. 2018 st mary's matriculation high school- Ariyalur Tamil nadu Andimadam --
kavarapalayam

VIII Std. 2019 st mary's matriculation high school- Ariyalur Tamil nadu Andimadam --
kavarapalayam

IX Std. 2020 st mary's matriculation high school- Ariyalur Tamil nadu Andimadam --
kavarapalayam

X Std. 2021 st mary's matriculation high school- Ariyalur Tamil nadu Andimadam --
kavarapalayam

XI Std. 2022 Don Bosco Hr Sec School Varadarajanpet Ariyalur Tamil nadu Andimadam --

XII Std. 2023 Don Bosco Hr Sec School Varadarajanpet Ariyalur Tamil nadu Andimadam --

Academic Information
Qualifying Examination: HSC Name of the Board of Examination: Tamil nadu Board of Higher Secondary Education
Permanent register number: 2212468110 HSC Roll number: 7468355
Qualified Year: 2023 HSC Group: HSC Academic
Group Code: Physics/ Chemistry/ Maths/ Biology Medium of Instruction: English
HSC maximum (total) marks: -- HSC obtained marks: --
SSLC maximum (total) marks: 500 SSLC obtained marks: 478
Have you applied for NEET ?: No Have you applied for JEE ?: No
Educational Management Information System(EMIS) Number: Community certificate number: TN-5202102028315
 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSION - 2023
Application for Admission to B.E/B.Tech Degree Course
Application Number: 236201

3316080200300641
Nativity certificate number (if applicable): TN-3202102024294
 GOVERNMENT OF TAMIL NADU
DIRECTORATE OF TECHNICAL EDUCATION
TAMIL NADU ENGINEERING ADMISSION - 2023
Application for Admission to B.E/B.Tech Degree Course
Application Number: 236201

DECLARATION BY THE APPLICANT

I, RAGUL R (Son / Daughter) of RAMASAMY 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, RAMASAMY R (Parent / Guardian) of RAGUL R 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 ADMISSION - 2023
Application for Admission to B.E/B.Tech Degree Course
Application Number: 236201

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 MBC & DNC (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