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Application No: 22882Government of Kerala
DEPARTMENT OF TECHNICAL EDUCATION
APPLICATION FOR ADMISSION TO M.TECH / M.PLANNING DEGREE COURSE
2015 - 16
1. Name in CAPITAL Letters, beginning from the left; initials at
the end of the name.(Please insert one letter in a box)S H A K I R
A P V
2. Postal Address D/O YOUSUF HAJI (LATE) SHAKIRA MANZIL ARANGADI
Affix KANHANGAD recentPin Code 671315 passport size photo
3 (a) Contact Telephone Number 4. Date of birth in Christian
EraSTD Code Land Phone Day Month Year0 4 6 7 2 2 0 4 7 7 6 1 5 0 9
1 9 8 7Mobile No. 9 8 4 6 8 6 2 0 6 6 E mail address,if any.
[email protected]
5 Sex Is Keralite Religion Caste Reservation Category
Non-CreamyLayer
Female Yes ISLAM MAPPLILA SEBC(OBC) No
6 Is GATE Qualified No
7 Details of Qualifying ExaminationDegree B.TechBranch Computer
Sc. & EngineeringUniversity COCHIN UNIVERSITY OF SCIENCE AND
TECHNOLOGYName of the College College of Engineering, Trikaripur
CETKRIs the College approved by AICTE YesYear of Passing 2009
Semwise Mark/SGPA DetailsSemesters Marks/SGPA Scored Total
Marks/SGPASem 1 & 2 1362 1700
Sem 3 890 1050Sem 4 867 1050Sem 5 796 1050Sem 6 823 1050
Total Marks in all Semesters up to and including sem 6
4738Maximum Marks in all Semesters up to and including sem 6
6950
8 Fee Amount 500
9 Whether Physically Challenged No
10 Sponsored Candidate No
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11 Choice of specialisation in the order of preferenceChoice
College Specialisation Category
1 KSD Computer Science & InformationSecurity
Non-GATE
DECLARATION(To be filled by the candidate)
I, .............................................................
hereby solemnly and sincerely affirm that the statements made and
informationfurnished in this application and also in the enclosures
thereof submitted by me are true to the best of my knowledge and
belief.Ihereby agree to abide by the rules and regulations of the
college,if admitted.
Place: Date: Signature of the Candidate
Note: 1.Late applications, those which do not contain the
necessary documents specified in clause of the prospectus and in
which any certificate is found defective, will
be rejected.2.Those who have not secured qualification from the
universities in Kerala state ,shall produce equivalency certificate
at the time of admission/counseling.
List of Enclosures:
Self attested true copy of Engineering Degree certificate and
Mark lists.
Self attested true copy of GATE Score card (for Candidates with
valid GATE Score) Self attested true copy of non creamy layer
certificate for candidates who claim eligibility under
SEBC(OBC)/OEC Self attested true copy of Community certificate
issued by the Tahsildar for candidates who claim eligibility for
reservation under SC/ST quota.
Self attested true copy of professional experience certificate
from the Head of the organizations where the candidate is working
in case of
those who passed AMIE/AMIETE.
Self attested true copy of Nativity Certificate.
Counterfoil of Chalan after remittance of application fee in any
branch of SBT.
Additional Certifiates:
Self attested true copy of Sponsorship Certiciate for candidates
applying under the sponsered category.
Self attested true copy of Physical Disability Certificate for
candidates who claim eligibility under the Physical Disability
quota.
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Instructions to Bank:Please note to enter the Application No and
Student name in the mandatory fields while posting the amount in
the Current Account.
STATE BANK OF TRAVANCORE Fee Payment Voucher
Bank Copy
Date:............................
Branch:Challan No: To be Filled by Student
Please credit the amount towards Application Fee to the account
of DIRECTORATE OF TECHNICAL EDUCATION Account No. 67179772330 with
SBT, Fort Branch,Trivandrum - code - 481.
Application No 22882 Name of Degree: MTECHName of Student:
SHAKIRA P VAmount: 500 Commission: 10Name and Address of
Student:
D/O YOUSUF HAJI (LATE)SHAKIRA MANZILARANGADIKANHANGAD 671315
Bank Seal
Cashier: Passing Officer:
Mobile Number: 9846862066
Amount in words: Five Hundred and Ten Only
Signature:.................................
Total: 510
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Student Copy
Date:............................
To be Filled by StudentBranch:Challan No:
Please credit the amount towards Application Fee to the account
of DIRECTORATE OF TECHNICAL EDUCATION Account No. 67179772330 with
SBT, Fort Branch,Trivandrum - code - 481.
Application No 22882 Name of Degree: MTECHName of Student:
SHAKIRA P VAmount: 500 Commission: 10Name and Address of
Student:
D/O YOUSUF HAJI (LATE)SHAKIRA MANZILARANGADIKANHANGAD 671315
Bank Seal
Cashier: Passing Officer:
Mobile Number: 9846862066
Signature:.................................
Total: 510
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Orginal Copy
Date:............................
Branch:Challan No:
To be Filled by Student
To be submitted along with the Application
_____________________________________
Please credit the amount towards Application Fee to the account
of DIRECTORATE OF TECHNICAL EDUCATION Account No. 67179772330 with
SBT, Fort Branch,Trivandrum - code - 481.
Application No 22882 Name of Degree: MTECHName of Student:
SHAKIRA P VAmount: 500 Commission: 10Name and Address of
Student:
D/O YOUSUF HAJI (LATE)SHAKIRA MANZILARANGADIKANHANGAD 671315
Bank Seal
Cashier: Passing Officer:
Mobile Number: 9846862066
Signature:.................................
Total: 510510
