Admission Enquiry Form

Personal Information

Name (as given in Std . X certificate)*

Date of Birth (Attach photo copy of the Std . X marks sheet for age proof)*

Gender : MaleFemale

Nationality : Indian Foreign

Religion*

Community*

NEET Information

NEET Score*

NEET Rank*

NEET Registration Number*

NEET attempts*

Counselling Information

Counselling type

Application No

General Rank

Community Rank

Contact Information

Phone Number

Country

State

Address

Pin Code

Educational Information

Qualification 1

Exam Passed

Month & Year of Passing

Name & Address of the School / College

University/Board

Overall%

Class / Division

Declaration

I hereby declare that the particulars given in the application form are true to the best of my knowledge and belief. I understand and agree that in case any information furnished is proved to be false or incorrect, my admission is liable for immediate cancellation, forfeiture of the fees paid by me and also any action the management might choose to pursue. I undertake to complete the course and in the event of discontinuation, I will pay the fee for the entire duration of the course. I also agree to abide by the rules and regulations of the institution at all times. Admissions are made at the absolute discretion of the management and any dispute whatsoever would be subject to the jurisdiction of courts at Chennai only.

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