K. RAMAKRISHNAN COLLEGE OF ENGINEERING SAMAYAPURAM, TRICHY – 621 112 2017-2018

Fresh Application form for Government Scholarship Scheme [ BC/MBC/DNC ] 1) Scholarship Type : Post Metric / First Graduate

2) Course & Department : B.E. Dept …………… M.E Dept…………. MBA

3) Year : I / II / III / IV Lateral Yes / No

4) Year of Admission : 20___

5) Name of the Applicant :

6) Roll No :

7) Anna University Registration Number :

8) 10th Register Number :

9) Parent / Guardian Name : Mother Name:

10) Parent / Guardian Occupation :

11) Date of Birth ( dd-mm- yyyy) :

12) Gender : Male / Female

13) Religion : Hindu / Muslim / Christian

14) Community : BC / BC(M) / MBC / DNC

15) Caste :

16) First Graduate in family : Yes / No Hosteller : Yes / No

17) Date of joining (academic Year) : Hostel Date of joining :

18) Permanent Address : Door No. Street Name :

19) Taluk :

20) District :

21) Pin code :

22) Individual Student Bank Account Number :

23) IFSC Code :

24) MICR Code :

25) Bank & Branch Name :

26) Bank Address: :

27) Bank Taluk , District & Pincode :

28) Student Phone Number & Email id :

BC/MBC/DNC Schyolarship -2017-18 [FRESH]

Enclosed

1) Counseling Allotment order Photocopy – 2 Nos.

2) First Graduation Certificate Photo Copy. – ( if applicable - )1 No

3) Students Bank Pass Book Photo Copy – 2 Nos (Individual Bank A/c in core nationalized bank with

ATM Facility. (IFSC Code, MICR CODE, Account Number- Full Digit) (No Joint Account Pass

Book Photocopy)

4) Community Certificate Photocopy – 1 no

5) Attendance Certificate (Original)

6) Income Certificate (Original) -2 Nos

7) Aaathar photocopy – 2 Nos

8) 10th & 12th Mark sheets photo copy – 1 Set.