ANNA UNIVERSITY :: CHENNAI - 600 025 APPLICATION FOR TAMIL NADU COMMON ENTRANCE TEST (TANCET) 2014 For

1) M.B.A. 2) M.C.A 3) M.E./M.Tech./M.Arch./M.Plan. Degree Programmes 2014-2015 --------------------------------------------------------------------------------------------------------------------------Date : 11/02/2014 Application Number 1. Name 2. Centre opting for Entrance Test 3. Choice of Entrance Test 4. Date of Birth 5. Gender 6. Nationality 7. Nativity 8. Community 9. 10th Std. Registration No./ Year 10. Year of Passing of HSC or Diploma : 57176 : SHILPA.S : Coimbatore : M.E./M.Tech./M.Arch./M.Plan : 08-Aug-1992 : Female : Indian : Other State : Others : 167065 / 2008 : 2010

11. Course Studied / Studying Details(For M.E./M.Tech./M.Arch./M.Plan.only) i) Course : B.E./B.Tech

ii) Specialisation / Group : ECE 12. Section under Part-III opted (For M.E/M.Tech/M.Arch/M.Plan only) i) Part No. : 5 ii) Subject : Electronics and Communication Engg. 13. Demand Draft Details DD Amount : 500 DD Number : 91273 DD Date : 05-Feb-2014

Bank Name : Other Bank 14. Name and Address for sending the Hall Ticket SHIVAKRIPA (PO)MADAPPALLY COLLEGE VATAKARA-2 CALICUT OTHERS CALICUT Pin : 673102 Phone / Mobile No. email id : 9496058958 : shilpasajikumar@gmail.com