Application No: 19UG24939

JAMAL MOHAMED COLLEGE (Autonomous)

7 , Race Course Road , TIRUCHIRAPPALLI - 620020. INDIA
College with Potential for Excellence
Re-accredited (3rd Cycle) with 'A' Grade by NAAC
(Affiliated to Bharathidasan University)
APPLICATION FOR ADMISSION - (2019)
U.G COURSES
(Un-Aided Courses-Men)

COURSE APPLIED FOR : B.C.A. - COMPUTER APPLICATIONS

For office use:

Admitted in : _________________________________________ on _____________________

Language Under Part I : Tamil Arabic French Hindi Urdu

Applicant's Name (In English) RILWAN RAKKEES M M

Address for Communication Permanent Address

_______________________________________________________________________________________________________________
30,KOMAN WEST STREET 30,KOMAN WEST STREET
_______________________________________________________________________________________________________________

TUTICORIN TUTICORIN
_______________________________________________________________________________________________________________

Tamil Nadu Tamil Nadu

_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Pincode: 628204
______________________________________________________________________________________________________________
Pincode: 628204
E-mail: rakkyrilwan@gmail.com Mobile No: 6374108048

Nationality : INDIAN

Date of Birth : 08/08/2001 Aadhar Card No. :

Place of Birth : TUTICORIN

Religion & Community : ISLAM LABBAI & BCM Caste : BC LABBAI

Blood Group : B +VE Mother Tongue :

Distinction in Sports : No.

Extra Curricular Activites / Co-Curricular Activites : No

______________________________________________________________________________________________________________
Whether differently-abled : No

Whether son of Ex-serviceman : No

Hostel accommodation : No

PARTICULARS OF THE PARENTS/GUARDIAN

Father's Name (in English) MOHAMED MOHIDEEN

Occupation CAR DRIVER

_________________________________________________ Annual Income 8248
__________________________

Contact No. 8610050767

__________________________ Email ID mohudoom.mech.ccet@gmail.com
______________________________
Mother's Name RAHMATH AYSHA
__________________________________________________________________________________________
Occupation HOME MAKER
___________________________________________ Annual Income ________________________________
Contact No. ______________________________ E-mail ID ________________________________________________
Guardian's Name (if living with guardian) ____________________________________________________________________
Contact No. ________________________________ E-mail ID ______________________________________________

PARTICULARS OF PREVIOUS ACADEMIC RECORD

Qualifying exam passed : HSC

Institution last attended : CENTRAL HIGHER SECONDARY SCHOOL

(With Address & Contact Nos) : TUTICORIN

EXTRACT OF THE MARK STATEMENT(S) OF THE QUALIFYING EXAMINATION PASSED

Subjects Register No Mark Maximum Marks Month Year No.of Attempts

Arabic 1077080 175 200 Apr 2018 1
English 1077080 119 200 Apr 2018 1
Physics 1077080 133 200 Apr 2018 1
Chemistry 1077080 133 200 Apr 2018 1
Maths 1077080 123 200 Apr 2018 1
Biology 1077080 107 200 Apr 2018 1
Total Marks Secured 790 1200

NOTE
1. Fill up the application form as per the data mentioned in your +2 Mark sheet & T.C.
2. Omission or withholding details required or giving incorrect information will result in summary rejection of application or
cancellation of admission.

Our College does not collect capitation fee for admission to any course

DECLARATION

* I declare that particulars given here are correct and I will, if admitted, abide by the rules and regulations of the College. I assure
that I will not take part in political or agitational activities inside or outside the College and I further promise that I will
behave in a manner that will bring credit to the College and to our Country

* I am aware of the law regarding the prohibition of ragging as well as the punishments and if found guilty of the offence of
ragging and / or abetting ragging, is liable to be punished appropriately. I agree to abide by the punishment in case I am found
guilty of ragging and / or abetting ragging.

Date :24/04/2019

Station : Signature of the Parent/Guardian Signature of the Student

Name :

--------------------------------------------------------------------FOR OFFICE USE ONLY--------------------------------------------------------------

Certificates verified

HSC Marks Community Transfer

Conduct Spl. Category

Signature of Staff Who Processed the application :___________________________________

Signature of Head of the Department : ____________________________________________ ADMITTED
Date of Payment :
Bill No :
PRINCIPAL
Application No: 19UG24938

JAMAL MOHAMED COLLEGE (Autonomous)

7 , Race Course Road , TIRUCHIRAPPALLI - 620020. INDIA
College with Potential for Excellence
Re-accredited (3rd Cycle) with 'A' Grade by NAAC
(Affiliated to Bharathidasan University)
APPLICATION FOR ADMISSION - (2019)
U.G COURSES
(Un-Aided Courses-Men)

COURSE APPLIED FOR : B.B.A. - BUSINESS ADMINISTRATION

For office use:

Admitted in : _________________________________________ on _____________________

Language Under Part I : Tamil Arabic French Hindi Urdu

Applicant's Name (In English) RILWAN RAKKEES M M

Address for Communication Permanent Address

_______________________________________________________________________________________________________________
30,KOMAN WEST STREET 30,KOMAN WEST STREET
_______________________________________________________________________________________________________________

TUTICORIN TUTICORIN
_______________________________________________________________________________________________________________

Tamil Nadu Tamil Nadu

_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Pincode: 628204
______________________________________________________________________________________________________________
Pincode: 628204
E-mail: rakkyrilwan@gmail.com Mobile No: 6374108048

Nationality : INDIAN

Date of Birth : 08/08/2001 Aadhar Card No. :

Place of Birth : TUTICORIN

Religion & Community : ISLAM LABBAI & BCM Caste : BC LABBAI

Blood Group : B +VE Mother Tongue :

Distinction in Sports : No.

Extra Curricular Activites / Co-Curricular Activites : No

______________________________________________________________________________________________________________
Whether differently-abled : No

Whether son of Ex-serviceman : No

Hostel accommodation : No

PARTICULARS OF THE PARENTS/GUARDIAN

Father's Name (in English) MOHAMED MOHIDEEN

Occupation CAR DRIVER

_________________________________________________ Annual Income 8248
__________________________

Contact No. 8610050767

__________________________ Email ID mohudoom.mech.ccet@gmail.com
______________________________
Mother's Name RAHMATH AYSHA
__________________________________________________________________________________________
Occupation HOME MAKER
___________________________________________ Annual Income ________________________________
Contact No. ______________________________ E-mail ID ________________________________________________
Guardian's Name (if living with guardian) ____________________________________________________________________
Contact No. ________________________________ E-mail ID ______________________________________________

PARTICULARS OF PREVIOUS ACADEMIC RECORD

Qualifying exam passed : HSC

Institution last attended : CENTRAL HIGHER SECONDARY SCHOOL

(With Address & Contact Nos) : TUTICORIN

EXTRACT OF THE MARK STATEMENT(S) OF THE QUALIFYING EXAMINATION PASSED

Subjects Register No Mark Maximum Marks Month Year No.of Attempts

Arabic 1077080 175 200 Apr 2018 1
English 1077080 119 200 Apr 2018 1
Physics 1077080 133 200 Apr 2018 1
Chemistry 1077080 133 200 Apr 2018 1
Maths 1077080 123 200 Apr 2018 1
Biology 1077080 107 200 Apr 2018 1
Total Marks Secured 790 1200

NOTE
1. Fill up the application form as per the data mentioned in your +2 Mark sheet & T.C.
2. Omission or withholding details required or giving incorrect information will result in summary rejection of application or
cancellation of admission.

Our College does not collect capitation fee for admission to any course

DECLARATION

* I declare that particulars given here are correct and I will, if admitted, abide by the rules and regulations of the College. I assure
that I will not take part in political or agitational activities inside or outside the College and I further promise that I will
behave in a manner that will bring credit to the College and to our Country

* I am aware of the law regarding the prohibition of ragging as well as the punishments and if found guilty of the offence of
ragging and / or abetting ragging, is liable to be punished appropriately. I agree to abide by the punishment in case I am found
guilty of ragging and / or abetting ragging.

Date :24/04/2019

Station : Signature of the Parent/Guardian Signature of the Student

Name :

--------------------------------------------------------------------FOR OFFICE USE ONLY--------------------------------------------------------------

Certificates verified

HSC Marks Community Transfer

Conduct Spl. Category

Signature of Staff Who Processed the application :___________________________________

Signature of Head of the Department : ____________________________________________ ADMITTED
Date of Payment :
Bill No :
PRINCIPAL