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St. Xavier'S College: Application Form 2018 - 2019

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APP. NO.

: UG
ST. XAVIER'S COLLEGE 5699 AIDED
(AUTONOMOUS)
PALAYAMKOTTAI - 627 002
APPLICATION FORM 2018 – 2019 B.Com SHIFT - I

Department No. :
(to be filled by the office) 18COM
Applicant Name UMAMAHESHWARI
Date of Birth /Age 18/11/2001 / Blood Group A+
Sex FEMALE Mother Tongue TAMIL
Recent Colour
Nationality INDIAN Religion HINDU
Passport Size
Catholic NO Dalit Catholic NO Photo of the Candidate
Community SC Sub-Caste/Cer.No. HINDUPALLAN / 8725649 to be affixed

Native Place ALAGAPURI District TIRUNELVELI


Annual
Parent’s Details Education Occupation
Income
Father Name CHINAMURUGAN 8TH FARMER 21000
Mother Name MAHALAKSHMI 10TH FARMER 21000
For Office Use
Guardian Name Relationship
8508825610 / Guardian Mobile
Parent Mobile No.
8508825610 No
Physically
NO If Yes Specify
Challenged
Son / Daughter of Ex-Serviceman of Tamilnadu Origin NO
Principal
Tamil origin From Andaman – Nicobar Islands? NO
Distinction in Sports NO NCC/NSS NO
Last Studied School Name VNUP KALIESWARI HIR SEC SCHOOL
Place VANNIAMPATTY
Qualifying Examination Passed HSC Month & Year MARCH 2018
AADHAR NUMBER: 618014525367
HSC REGISTER NUMBER: 1123115
PAYMENT DETAIL: FREE
SUBJECTS

(1) LANGUAGE TAMIL 148 / 200


(2) LANGUAGE ENGLISH 120 / 200
(3) SUBJECT ECONOMICS 151 / 200
(4) SUBJECT HISTORY 147 / 200
(5) SUBJECT COMMERCE 126 / 200
(6) SUBJECT ACCOUNTANCY 168 / 200

TOTAL MARKS (3- 6) 592 / 800 (1 - 6) 860 / 1200


PERCENTAGE (3 - 6) 74 % 100 (1 - 6) 71.67 % 100
APP. NO.:
UG B.Com SHIFT - I
5699 AIDED

Address for Communication (Present Address)


DOOR
1/140 STREET SOUTH STREET
NUMBER
CITY SANKARANKOVIL DISTRICT TIRUNELVELI
STATE TAMIL NADU PIN CODE 627719
MOBILE
8508825610 E-MAIL ID uthandarasu1990@gmail.com
NUMBER
Permanent Address( Fill with Blue or black ball point pen)
DOOR
STREET
NUMBER
CITY DISTRICT
STATE PIN CODE
MOBILE
E-MAIL ID
NUMBER
DECLARATION
I ................................................................................... understand that association with any
unlawful organisation during the course of my study in the College is forbidden. If selected for
admission, I promise to abide by the rules and regulations of the college. All the particulars
stated in this application are true to the best of my knowledge and belief.
Date:
Signature of the Applicant
UNDERTAKING BY PARENT OR GUARDIAN
If, my son / daughter ........................................................................................................ is
Admitted to the college, I undertake to pay regularly all his / her dues to the college till the
completion of his / her course of studies. I also undertake to be responsible for his / her
conduct, Progress in studies and attendance.
Date:
Signature of the Parent / Guardian
ONLY FOR CATHOLIC

I Rev. Fr. .........................................................................Certify that the applicant belongs to my


parish.
Signature of the Parish Priest
Please enclose the attested copies of the following certificates. Write the application No. on top
of each sheet:
1. Qualifying Examination Mark Sheet (HSC)
2. Community Certificate (BC / BCM / MBC / DNC / SC / ST /SCA)
3. A letter from the Parish Priest for Roman Catholics.
4. Certificate of Proof for Differently Abled: Physically Challenged / Sports / NCC /
NSS / Ex. Serviceman etc.

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