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STUDENT APPLICATION CUM REGISTRATION FORM

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Education Details

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Education Details Add Attempt Details (If failed in any subject):

Marks obtained*

Subject
Maximum mark
Mark secured
Month & year passed
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Total
Percentage
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Application Number: {{aplForm.AplnNum}}

JAMAL MOHAMED COLLEGE (Autonomous)

7, Race Course Road, TIRUCHIRAPPALLI - 620020. INDIA
APPLICATION FOR ADMISSION - ({{aplForm.acYrNm}})

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Course applied for: {{aplForm.crsNm}} Course Choice 1: {{crsOneNm}} Course Choice 2: {{crsTwoNm}}
For office use:
Admitted in: __________________________________________ on ________________
Language under part I *:
Tamil
Arabic
French
Hindi
Urdu PRINCIPAL
Applicant's Name: {{aplForm.aplcntNm}}
Date of Birth : {{aplForm.DOB}} Nationality : {{aplForm.Natnl | uppercase}}
Place of Birth : {{aplForm.CnBpl | uppercase}} Aadhar Card No. : {{aplForm.NatID}}
Religion & Community : {{aplForm.Rlig | uppercase}} & {{aplForm.communityCtgry | uppercase}} Caste : {{aplForm.Comnty | uppercase}}
Blood Group : {{aplForm.bloodGrp}}- Mother Tongue : {{aplForm.MothTng | uppercase}}-
Mobile Number : {{aplForm.CnAdMob}}- Email Id : {{aplForm.CnEmail}}-
Distinction in Sports : {{aplForm.sports | uppercase}}- Extra Curricular Activities / Co-Curricular Activities : -
Whether Differently-Abled : {{aplForm.CnKnDis | uppercase}}-
Whether Son of Ex-Serviceman : {{aplForm.OthInfo | uppercase}}-
Hostel Accommodation : YES -
PARTICULARS OF PREVIOUS ACADEMIC RECORD
Qualifying Exam Passed : {{ql.QlfyEx}}-
School Last Studied Institution Last Attended : {{ql.Inst | uppercase}}-
Name of the University : {{ql.Univ | uppercase}}-
Month and Year of Passed/Appeared : {{ql.DateOfPass | date: 'MMM/yyyy'}}-
Address : {{ql.InstAdL1 | uppercase}} - {{ql.InstPl | uppercase}} -
Specify the Major : {{ql.Medium | uppercase}}-
Qualifying Exam Passed : {{ql.QlfyEx}}-
Register No. : {{ql.RegNo}}
Subjects Mark Maximum Marks Month & Year No. of Attempts
{{ms.CnSubj}} {{ms.Scored}} {{ms.MaxMark}} {{ms.mnYrAprd | date: 'MMM/yyyy'}} {{ms.NoOfAtt}}
Total Marks Secured {{ql.TotMrk}} {{ql.Ovraltot}} Percentage: {{ql.Percent}} %
Total Percentage of Marks I to V Semester in Part-III Alone : {{aplForm.SchlrshipCmt}}-
Total Percentage of Marks I to VI Semester in Part-III Alone : {{aplForm.Rmrks}}-
TANCET/CONSORTIUM Marks : {{aplForm.EntranceScore}}
PARTICULARS OF THE PARENTS/GUARDIAN
Father's Name : {{aplForm.FatNa | uppercase}}- Occupation : {{aplForm.FatOcc | uppercase}}-
Annual Income : {{aplForm.FatInc}}- Contact No. : {{aplForm.FatAdMob}}-
Email Id : {{aplForm.FatEmail}}-
Mother's Name : {{aplForm.MotNa | uppercase}}- Occupation : {{aplForm.MotOcc | uppercase}}-
Annual Income : {{aplForm.MotInc}}- Contact No. : {{aplForm.MotAdMob}}-
Email Id : {{aplForm.MotEmail}}-
Guardian's Name : {{aplForm.GrdnNa | uppercase}}- Contact No. : {{aplForm.GrdnAdMob}}-
Email Id : {{aplForm.GrdnEmail}}-
Address for Communication Permanent Address
{{aplForm.CnAdL1 | uppercase}} {{aplForm.CnAdL1 | uppercase}} {{aplForm.PemAdd | uppercase}}
{{aplForm.CnAdCty | uppercase}} {{aplForm.CnAdCty | uppercase}}
{{aplForm.CnAdStat | uppercase}} {{aplForm.CnAdStat | uppercase}}
Pincode: {{aplForm.CnAdPin}} Pincode: {{aplForm.CnAdPin}}
Email: {{aplForm.CnEmail}} Mobile: {{aplForm.CnAdMob}}
NOTE
  1. Fill up the application form as per the data mentioned in your +2 Mark sheet & T.C.
  2. Omission or withholding details required or giving incorrect information will result in summary rejection of application or cancellation of admission.
Our College does not Collect Capitation Fee for Admission to Any course

DECLARATION

* I declare that the particulars given here are correct and I will, if admitted, abide by the rules and regulations of the College. I assure that I will not take part in political or agitational activities inside or outside the College and I further promise that I will behave in a manner that will bring credit to the College and to our Country
* I am aware of the law regarding the prohibition of ragging as well as the punishments and if found guilty of the offence of ragging and / or abetting ragging, is liable to be punished appropriately. I agree to abide by the punishment in case I am found guilty of ragging and / or abetting ragging.
Date: {{aplForm.currntDt | date: 'dd-MMM-yyyy'}}
Station: Signature of the Parent/Guardian Signature of the Applicant
Name:
FOR OFFICE USE ONLY
Signature of Staff Who Processed the Application: ___________________
Date of Payment:
Bill Number: