AMRITA VISHWA VIDYAPEETHAM

Application form for Master of Technology (M.Tech) for the year 2011
Application Number

Bank : STATE BANK OF INDIA

DD Date : 2011-05-10

Branch : KATTAPPANA

: ANOOP

Gender

: male

Date Of Birth : 1987-12-29

Religion

: Hindu

Community

: OTHERS

Marital Status :

Nationality : INDIAN

Name

DD Number : 246911

*watermarked Application*

(For Office use Only)

Signature of the Candidate

(With in the box using Black ball
point pen only)

Full Name and Postal Address of the Candidate

ta

ANOOP S

Pincode

ri

KERALA

: 685515

IDUKKI

KONDATTU,SANTHINAGAR,KATTAPPANA SOUTH,UDUMBANCHOLA

Phone No : 273204

Mobile No : 9496335483

E-Mail ID : anoopskondattu@yahoo.in

STD Code : 04868

Parent / Guardian Details

Name of the Parent / Guardian :

STD Code :

ta

Relationship with the Parent / Guardian :

Age :
Office Address :

ri

Parent's Annual Income :

Phone No :

Mobile No :

Email ID :

Academic Details of the Candidate

Semester /
Year #

Branch of Study : BTECH

Year of Passing : DECEMBER 2009

II

III

IV

VI

VII

VIII

Scored

1119

1119

659

611

629

699

673

634

Maximum

1700

1700

1050

1050

1050

1050

1100

1000

Percentage

66

66

63

58

60

67

61

63

Gate Mark :
---------------Gate Percentile : 95.1

IX

Year Of Passing : 2010

Subjects Passed Inmore than one Attempt: (Attach Additional Sheet, If Required)

Title of the Subject

No.of Attempts S.No

Title of the Subject

No.of Attempts

ENGINEERING CHEMISTRY

04

INDUSTRIAL AND POWER ELECTRONI

02

SOLID STATE DEVICES AND CIRCUI

05

COMPUTER NETWORKS

03

DIGITAL ELECTRONICS

06

DIGITAL SYSTEM DESIGN

01

Period
From

Designation

To

Nature of Work

Organization

ta

S.No

Professional Experience

(A Sponsorship certificate is to be submitted in the format enclosed)

Pincode

State

District

STD Code :

Phone No :

Mobile No :

Email ID

ta

Name & Address :

ri

Name of the Sponsoring Organization, If Applicable

In Case of Married Female Candidates

Annual Income

Office Address

ri

Husband's Name :

Preference of Specialisation and Campus

Preference
01
02
03
04

Course

Campus

*watermarked Application*

S.No

If You Want to Add More Choices, Please Write Here

Campus

Address

Name

Local Guardian Details

STD Code :

Relationship with the Guardian :

Mobile No :

Phone No :

ta

Email ID :

ri

Declaration by Candidate and Parent / Guardian

I hereby declare that all particulars stated by me in this application are true and correct. If any

information furnished by me is found to be false or distorted, or if any information is found to be suppressed

to secure admission, I understand that, I will be denied admission, and if already admitted, my admission /
degree acquire is liable to be cancelled without any claim or consideration. I have read the information

Handbook before filling the application form. I promise to abide by the rules and norms of discipline of abide

ta

by the rules and norms of discipline of the university, if I am admitted.

Date :
Place :

ri

Signature of the Candidate with Name

OARS No

OARS No :2407

Signature of the Parent / Guardian with Name

*watermarked Application*

Course

Preference