1. Name (as in SSLC Book): 2. Expansion of Initial: 3. Date of Birth (as in SSLC Book): 7. Religion and Caste: 8. Community: SC ST OBC GENERAL 9. Address: 10. Name of Parent / Guardian: 11. Relationship: 12. Occupation of Parent or Guardian and Annual Income: 13. Whether a resident of Kerala? Yes No 13a. Name of Taluk and District: 14. Name of Institution last studied: 14a. Qualifying Examination Passed: 15. SSLC Examination Passed: 16. Number of chances taken: 17. Have you applied for management quota? Yes No 18. Are you eligible for NSS/NCC quota? 19. Have you represented in the National / State / University level? 26. Details of marks>

Subject	Marks Obtained	Maximum Marks	Grade	Index
Part I English
Part II Language
Part III Div:
1)
2)
3)
4)
Total of part III
Grand Total (Part I + Part II + Part III)

DECLARATION

I declare that the particulars given above are correct to the best of my knowledge and belief. I shall obey the rules and regulations of the college and undertake to attend classes and tests.

Place: Date: Signature of Applicant:

I hereby guarantee the good conduct of my ward and payment of fees. I agree to withdraw him/her in case of misconduct or failure in studies.

Guardian's Name: Phone No: Mob No: