P.T. Lee Chengalvaraya Naicker Polytechnic College

Personal Details

Name of the Candidate (In Block Letters)

Name of the Parent/Guardian

Address for Communication Include door number, street, city, district, and pin code

Email ID

Mobile Number

Nationality

Native District

Place of Birth

Mother Tongue

Gender

Female

Male

Transgender

Date of Birth (Day)

Month

Year

Community Details

Religion

Community

Caste (In Block Letters)

Community Certificate No.

Certificate Issued By

Revenue Division/Taluk

Upload Passport Photo Recent color photo (35mm x 45mm, max 100KB)

Educational Qualifications

Examination Passed

Year of Passing

Total Marks in SSLC/Equivalent

Marks Obtained in SSLC/Equivalent Examination

Subject	Marks Scored	Maximum Marks	Month & Year of Passing
Tamil or any other Language
English
Mathematics
Science
Social Science
Elective (if any)

Details of Studies

Class	Month & Year of Passing	Medium of Instructions	Name of the School and Address
IX Std.
X Std.

Additional Information

EMIS No.

Applicant's Aadhaar No.

Applicant's PAN No.

Parent's Mobile No.

Applicant's Mobile No.

Bank Account Details (if available, otherwise parents)

SB Account No.

IFSC Code

Bank

Branch

Course Preference

Important Note:

Please select your course preferences carefully. Admission will be based on merit and availability of seats.

Under Govt. Aided Scheme (Select in order of preference)

Under Self Supporting Scheme (Select in order of preference)

I hereby solemnly declare that the information furnished in the statements given in the application and the enclosures are true, correct and complete. I understand that any false information provided may result in cancellation of my admission.