Thiruvalluvar University - Serkadu, Vellore, Tamil Nadu, India

Name of the Bank & Branch

A/c No.

Date

Amount Paid (Rs.)

Name of Candidate (as per Certificate)

Address

Course Proposed

Subject of Study

Year of Joining

Phone No./Email ID

	Details of SSLC / GCE (Ordinary Level) or its equivalent qualifications i.e., 10^th or 11^th Std	Details of PUC / HSS / Intermediate / Pre-Degree / SSC / ISC / GCE Adv. Level or its equivalent qualifications	Details of B.A / B.Sc / B.Com / B.Ed / B.P.Ed etc. or its equivalent qualifications	Details of M.A / M.Sc / M.Com etc. or its equivalent qualifications
1. Name of the Examination Passed
2. Name of the School / College
3. Name of the Board / University
4. Register No.
5. Month & Year of Passing
6. Whether passed under Regular / Open University / Correspondence / Private Study
7. Total No. of Academic Years Studied	10 Years / 11 Years	1 Year / 2 Years	3 Years	2 Years
8. Passed / Failed
9. Max. Marks Prescribed for Pass
10. Total Marks Secured
11. Percentage of Marks
12. Whether He / She belongs to SC/ST
13. Details of Photocopy Certificates enclosed with the Application

Received all my Original Certificates after Verification

The above particulars are True and Correct

Signature of the Candidate with Date

Name of the Candidate

Admission Sought in

Amount Paid (Rs.)

Date of Submission