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    2012 Appl - Form.diploma - Agrl.science

    Uploaded by

    Sudheendranadhan KV
    This document is an application form for admission to the Diploma in Agricultural Sciences Course in 2012 under the Kerala Agricultural University. It requests information such as the applicant's name, address, date of birth, parents' details, educational qualifications and marks obtained, community certificate if applicable, and details of application fee payment. The applicant is required to declare that they have read and agree to abide by the admission conditions in the prospectus and that all information provided in the application is true. It contains sections for affixing a photo and signatures of the applicant and identifying officer. A format of community certificate for Scheduled Caste/Scheduled Tribe candidates from Kerala is also provided.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    2012 Appl - Form.diploma - Agrl.science

    Uploaded by

    Sudheendranadhan KV
    21 views3 pages
    This document is an application form for admission to the Diploma in Agricultural Sciences Course in 2012 under the Kerala Agricultural University. It requests information such as the applicant's name, address, date of birth, parents' details, educational qualifications and marks obtained, community certificate if applicable, and details of application fee payment. The applicant is required to declare that they have read and agree to abide by the admission conditions in the prospectus and that all information provided in the application is true. It contains sections for affixing a photo and signatures of the applicant and identifying officer. A format of community certificate for Scheduled Caste/Scheduled Tribe candidates from Kerala is also provided.

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    2012 Appl.form.Diploma.agrl.Science

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    This document is an application form for admission to the Diploma in Agricultural Sciences Course in 2012 under the Kerala Agricultural University. It requests information such as the applicant's name, address, date of birth, parents' details, educational qualifications and marks obtained, community certificate if applicable, and details of application fee payment. The applicant is required to declare that they have read and agree to abide by the admission conditions in the prospectus and that all information provided in the application is true. It contains sections for affixing a photo and signatures of the applicant and identifying officer. A format of community certificate for Scheduled Caste/Scheduled Tribe candidates from Kerala is also provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    21 views3 pages

    2012 Appl - Form.diploma - Agrl.science

    Uploaded by

    Sudheendranadhan KV
    This document is an application form for admission to the Diploma in Agricultural Sciences Course in 2012 under the Kerala Agricultural University. It requests information such as the applicant's name, address, date of birth, parents' details, educational qualifications and marks obtained, community certificate if applicable, and details of application fee payment. The applicant is required to declare that they have read and agree to abide by the admission conditions in the prospectus and that all information provided in the application is true. It contains sections for affixing a photo and signatures of the applicant and identifying officer. A format of community certificate for Scheduled Caste/Scheduled Tribe candidates from Kerala is also provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    KERALA AGRICULTURAL UNIVERSITY

    VELLANIKKARA 680 656

    Application for Admission to Diploma in Agricultural Sciences Course 2012


    UNDER THE KERALA AGRICULTURAL UNIVERSITY

    [Read the Prospectus and instructions before filling the application]


    Roll No...
    (To be given by Office)

    I certify that the photograph is that of Sri./Smt.


    ...........................
    Signature of the Identifying Officer......................
    Name :
    Address:

    Name of applicant in block letters (initials last)


    Please state Male or Female

    Address of the applicant with district and PIN code


    Telephone number with STD code
    Mob. No.
    E-mail id:

    Date of birth in Christian Era (dd/mm/yy)


    (Enclose copy of proof of Date of Birth)

    Name, address and occupation of parent/guardian


    Telephone number if available, with STD code

    Have you produced Nativity Certificate to show that


    you are an Indian citizen of Kerala origin? Please
    write Yes or No

    Do you belong to any Scheduled Caste or Scheduled


    Tribe? (Please see Appendix I). Please write Yes or
    No. If Yes, please write the name of the
    Community

    Affix recent
    passport size
    photograph

    Details of qualifying examinations passed and


    marks secured
    (a) Name of the examination passed

    ...................................................................................................

    (b) Register No. and Year

    ...................................................................................................

    (c) Name of University or Board

    ...................................................................................................

    Details of marks secured


    Maximum
    Marks

    Marks
    secured

    ..............................................

    ......................................

    .............

    ...............................................

    ......................................

    ............................................

    ..

    ..............................................

    ......................................

    ..............................................

    .....................................

    ..............................................

    .....................................

    ..............................................

    ....................................

    Subject

    .............................
    ............................
    ............................

    Total:

    Grand total

    8.

    Percentage of marks

    9.

    Details of application fee remitted


    (DD No. & Date)

    DECLARATION
    (i)

    I hereby declare that I have fully read the conditions for admission to the Course as contained in the Prospectus
    and agree to abide by these.

    (ii)

    I hereby solemnly and sincerely affirm that the statements made and information furnished in my application form
    and also in the enclosures there to submitted by me are true. Should it however be found that any information
    furnished therein is untrue in material particular, I realise that I am liable for criminal prosecution and also agree to
    forego my seat.

    Place :
    Date :

    Signature of the Applicant

    (1) - COMMUNITY CERTIFICATE


    (For Scheduled Castes & Scheduled Tribes candidates)

    This is to certify that Shri./Smt./Kumari ........................... .........


    son/daughter of Sri./Smt..................................................................
    House........................................., Village/Town .......................................................,
    Taluk ................., District ......................................................................... of Kerala State
    belongs to the .................................................................. Caste/*Tribe, which is recognized as a
    Scheduled Caste/Scheduled Tribe under:-

    Certified that Shri/Smt/Kumari .........................................................................


    S/o or D/o ............................................................ House .............................................................................................,
    Village ......................., Taluk ....................................................................................
    District .. is a member of Malai Araya Christian family converted to Christianity from
    Hindu Malai Arayan Community, which is included in the list of Scheduled Tribes.

    2.

    Shri/Smt/Kumari ..

    and his/her* family ordinarily reside(s) in ......................................


    Village/Town of District of Kerala State.

    Signature of Tahasildar

    Name

    Place :
    Date :

    (OFFICE SEAL)

    -----------------------------------------------------------------------------------------------------------------------------------------------------* Please delete the words which are not applicable


    Note: 1. The term "ordinarily resides" used here will have the same meaning as in Section 20 of the Representation of the
    Peoples Act, 1950
    2. Xian converts from S.C. who have subsequently embraced Hinduism should get the following certificate recorded
    by the Tahasildar below the Community Certificate. The certificate is issued after observing the guidelines
    issued in Government Circular No.18421/E2/87/SC/ST/DD dated 15-12-1987.
    3. Issue of Community Certificate to Scheduled Caste/Scheduled Tribe will be regulated by Act II of the Kerala
    (Scheduled Caste & Scheduled Tribe) Regulation of issue of Community Certificate Act, 1996.
    4. Certificate to persons belonging to Malai Arayan Community (S.T.) converted to Christianity should be in this
    form

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