Application No.

: 37078

NATIONAL INSTITUTE OF TECHNOLOGY

APPLICATION FOR COMMON ADMISSIONS TO M.Tech. PROGRAMMES

(2010 - 2011)

NITs at Agartala, Calicut, Rourkela, Surathkal, Tiruchirappalli & Warangal

Registration Number : (for Office use only)

____________________________________________________________________________________________________

1. Personal Details

(a) Name : KARUNANIDHI. V (b) Date of Birth : 20 - MAR - 1984

(c) Marital Status : Single (d) Sex : Male

(e) Father's/Guardian's/Husband's Name : VARADAN. V

2. Education Details

(a) Qualifying Degree : BE

(b) Branch : Electrical & Electronics

(c) Marks Obtained : 74.52 Percentage (Upto 8th Sem) (d) Qualifying Year : 2005 - APR

(e) Qualifying Examination Status : Degree Completed

3. GATE Details

(a) Registration No : EE7058506 (b) Score : 533.00

(c) Marks out of 100 : 41.33 (d) All India Rank : 1412

(e) Year of Appearance : 2010 (f) Examination Paper : Electrical Engg

4. Category : OBC

5. Physically Challenged : No

6. Nationality : Indian

7. Mailing Addres

6A, Melkattamman koil back street,Nangayar kulam,Uttiramerur, Kancheepuram District, Tamil Nadu - 603406
8. Permanent Address

6A, Melkattamman koil back street,Nangayar kulam,Uttiramerur, Kancheepuram District, Tamil Nadu - 603406

9. Phone (Landline) : N/A

10. Mobile : 9790149197

11. E-Mail : v.karunanidhi@gmail.com

12. DD Details

(a) DD Number : 695501 (b) DD Date : 24 - MAY - 2010

(c) Bank Name : SBI, Tiruvanmiyur (d) Amount (in rupees) : 300

I accept that if any of the information mentioned above is found to be false or misleading I will be disqualified from admission.

Date : Applicant's Signature

Instructions to send the Application Form

1) Affix your recent passport size photograph on top corner and sign the application form.

2) Attach apprppriate photocopies of certificates found in the list of enclosures.

3) Attach a Demand Draft of appropriate amount drawn in favour of The Director, National Institute of Technology,
Tiruchirappalli - Payable at Tiruchirappalli from any nationalized bank.

4) Send the application form through courier/speed post to the following address on/or before 31st May 2010.

Admissions Co-ordinator (M.Tech. Admissions 2010)

Office of the Dean (Academic Programmes)
National Institute of Technology
Tiruchirappalli - 620 015
Tamil Nadu
Phone: 0431-2503010