GOVERNMENT OF TAMIL NADU

DIRECTORATE OF TECHNICAL EDUCATION

TAMIL NADU ENGINEERING ADMISSIONS 2019

Application No. : 130104

Personal Information
Name KRISHNAKAMAL KN Nativity Tamil Nadu
Parent Name KANTHAPPAN Religion HINDU
26,KASUKKARA
STREET,MANNARGUDI,THIRUVARUR-
Permanent Address Community BC
614001 THIRUVARUR TAMIL NADU -
614001
Mobile Number 9080190665 Caste Name - Code Kallar.-341
Email krishnakamal190@gmail.com Aadhar Number 420025967761
Date of Birth 04-05-2002 Nationality INDIAN
Gender MALE
Special Reservation Information
Eminent Sports Person YES Differently Abled Person NO
Exservicemen NO
Scholarship Information
Annual Income Below Rs. 1,00,000
Availed First Graduate Tuition Fee
First Graduate Tuition Fee Concession YES YES
Concession
AICTE Tuition Fee Waiver (TFW)
YES Post Matric Scholarship
Scheme
School of Study Information
Studied VIII, IX, X, XI & XII Std. in Tamil Nadu School of Study YES
Class Year of Passing Name of the School District State
ASHOKA SISHUVIHAR
VIII Std. 2015 THIRUVARUR TAMIL NADU
MATRIC SCHOOL
ASHOKA SISUVIHAR
IX Std. 2016 THIRUVARUR TAMIL NADU
MATRIC SCHOOL
ASHOKA SISUVIHAR
X Std. 2017 THIRUVARUR TAMIL NADU
MATRIC SCHOOL
SRISHANMUKA MATRIC
XI Std. 2018 THIRUVARUR TAMIL NADU
HR SEC SCHOOL
SRISHANMUKA MATRIC
XII Std. 2019 THIRUVARUR TAMIL NADU
HR SEC SCHOOL

Academic Information
Qualifying Examination HSC
Name of the Board of Examination Tamilnadu-Tamilnadu Board of Higher Secondary Education
HSC/Equivalent Register Number & Year : 4535991 - 2019
HSC Group & Group Code : HSC Academic - 103
Marks Obtained in HSC (Academic/Equivalent) Examination
Subject Register Number Month Year Maximum Mark Obtained Mark
Physics 1843535817 Mar 2019 100 80
Chemistry 1843535817 Mar 2019 100 87
Mathematics 1843535817 Mar 2019 100 52
Optional 1843535817 Mar 2019 100 73

Civic Information
Mother Tongue TAMIL Civic Native Corporation
Medium Of Instruction ENGLISH Civic School Municipality
Parent Occupation Others Native District THIRUVARUR
 TAMIL NADU ENGINEERING ADMISSIONS 2019
Application for Admission to B.E/B.Tech Degree Course
Application No. : 130104

The Following Original Certificates have to be produced at TFC, at the time of Certificate Verification.
Venue, Date and Time will be intimated through SMS to the registered mobile and Email id.

1. Transfer Certificate

2. 10th Mark Sheet

3. 11th Mark Sheet

4. 12th Mark Sheet

5. HSC Hall Ticket

6. Permanent Community Certificate Card (Permanent card / electronic form / digitally signed e-Certificate)

7. Income Certificate of the Parent if applicable

8. Nativity Certificate if applicable

9. Special Reservation Form For Sports and relevant certificates if applicable

10. Special Reservation Form For Ex-serviceman and relevant certificates if applicable

11. Special Reservation Form For Differently Abled and relevant certificates if applicable

Printout of the application, Signed declaration and photocopies of all the above mentioned certificates need to be submitted at TFC, at
the time of Certificate Verification.
 TAMIL NADU ENGINEERING ADMISSIONS 2019
Application for Admission to B.E/B.Tech Degree Course
Application No. : 130104
Recent
Passport
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Photo

DECLARATION BY THE APPLICANT

I,KRISHNAKAMAL KN( Son / Daughter) of KANTHAPPAN 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 Tamilnadu 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
upto 3 years,and / or fine upto Rs. 25,000/-

Place :
(Signature of Applicant)
Date :

DECLARATION BY THE PARENT / GUARDIAN

I,KANTHAPPAN (Parent / Guardian) ofKRISHNAKAMAL KN 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 Institition 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 Tamilnadu 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 upto 3 years,and / or fine upto RS. 25,000/-

Place :
(Signature of Parent / Guardian)
Date :

Note: Guardian can execute the above declaration,only if both the parents are not alive.
Name of the Candidate : Application Number :
List of the Details of All Sports Certificates Enclosed:-
(Achievements of International, National, State, Divisional and District Level, in the descending order- If, more number of Achievements, take
additional print out and may be listed)
Eligible Marks
Name of the Name of the Meet / Tournament / Sports Month & Year
S.No Gold / Silver / Bronze / Remarks
Certificate / Form Championship Discipline Issue
Participation
2018 - 2019 (Academic Year)
1
2
3
4
5
2017 - 2018
1
2
3
4
5
2016 - 2017
1
2
3
4
5
2015 - 2016
1
2
3
4
5

Declaration
The information furnished above and all the enclosures submitted by me are true. Should however be found that any information furnished
therein untrue with respect to sports details, I realize that I am liable for criminal prosecution and I also agree to the forfeiture of my seat under
sports quota

Signature of the Parent Signature of the Candidate

Date :
Name of the Candidate : Application Number :
Details of Sports Certificates enclose *
Eligible Marks (As per the Guidelines)
International / Name of Month & Year Relevant Forms
Academic Sports Total
National / State / the Sports (From June 2015 I/II/IV enclosed Gold (I Silver Bronze
Year Discipline (II (III Participation Marks
Divisional Meet to May 2019) (Yes/No) position)
position) position)
2018-19 (XII
Std.)
2017-18 (XI
Std.)
2016-17 (X
Std.)
2015-16 (IX
Std.)
Total No. of
Grand
Certificates
Total
enclosed

*Highest achievement / Participation certificates obtained by candidate at different levels such as District or State or National or International in
each year along with earlier achievements should be enclosed without fail.
However, the candidates are advised to submit all the certificates by arranging in an order.

Candidates seeking admission against Special Reservation of seats under Eminent Sports Persons Quota should produce all their original sports
documents (sports certificates and appropriate forms) along with all other certificates mentioned in the registered application for certificates
verification at TNEA Facilitation Centre (TFC), CIT Campus, Tharamani, Chennai 600 025 on the prescribed date and time which will be
intimated through SMS to the registered mobile number and e-mail.

Declaration
The information furnished above and all the enclosures submitted by me are true. Should it however be found that any information furnished
therein is untrue with respect to sports details, I realise that I am liable for criminal prosecution and I also agree to the forfeiture of my seat under
sports quota.

Signature of the Parent Signature of the Candidate

Date :