NH-47 Ariyanoor Salem Tamil Nadu
Recognized by U.G.C
Approved by Distance Education Council,
IGNOU,
Admn.
Appln.
No
.
APPLICATION FORM FOR ADMISSION
(With in CAPITAL letters only)
Enrollment No. :
(For Office use only)
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Academic year
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Course and Specialty Applied for
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Year Applied
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Name of the Study Centre
: APARK INSTITUTE OF EMPLOYMENT
EDUCATION AND RESEARCH
1.
Name
of the Applicant as in the Birth Certificate of Marks card of Standards X Exam.
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2. Fathers
Name
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3. Sex : Male
Female --------------- 4.
Date of Birth & Age: ------------------------ Date: Month-------------------------------Year------------------------------
Age-----------------------------
5. a) Personal Marks of Identification : --------------------------------------------b) blood
Group :
---------------------------------------------------------------------------
6. Address
for Correspondence (do not repeat name)
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City State
Pin Code:
---------------------------------
Country STD
Code Phone
7.
Permanent
Address (do not repeat name)
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City State Pin Code:
------------------------------------
8. a) Nationality :
b) Religion
: (√ Tick) Hindu Christian Muslim Others
c)
Community: (√ Tick)
d)
Caste :
e) State : f) Region : Rural
Urban
9.
Details
of Educational Qualifications (From X Standard onwards)
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S.No. |
Name of the Qualifying Exam. |
Month & Year of Passing |
Name of the School / College Studied |
Name of the University / Board |
Certificate No. |
% Obtained |
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10. Employment
Details
a)
Employed : (√ Tick) Yes No
b) Senior Mgt. Middle Mgt. Others
c)
Designation
d)
Name
of the Company / Institution
e)
Address
of the Company / Institution
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City
State Pin Code
:
-------------------------------------
a)
Name of the Bank
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b) DD Number
c) DD
Date Date
Month Year
d)
Rupees (in words)
DECLARATION
I hereby declare that, the information furnished
herein are true and correct to the best of my knowledge and belief.
I have read the prospectus and the rules
and regulations of the University.
In case any information furnished is
found incorrect, at any stage I agreed to forego the claim for admission
Signature of the Applicant
Place :
Date:
___________________________________________________________________________________________
Details of Xerox copies of the
certificates submitted by the candidate at the time of admission
:
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S.No. |
Particulars
of Certificate |
Certificate Sl. No. |
Reg. No.,
Month & Year of Passing |
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1. |
10th STD Mark Sheet(s) |
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2. |
H.Sc. or Equivalent Mark sheet(s) |
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3. |
Degree Mark Sheet___________Nos. |
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4. |
Provisional Certificate |
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5. |
Degree Certificate |
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6. |
Migration Certificate |
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7. |
Transfer Certificate |
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8. |
Community Certificate |
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9. |
Other Certificate (s) if, any
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Declaration of the Candidate
I declare that all the above Xerox
copies of the certificates submitted by me at the time of admission are true
and genuine
Note: Please enclosed the photocopies of
your previous educational mark sheets with Four
passport size photographs with this form
Signature of the Candidate