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B.tech _application_2012

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Application No:
Application for Admission to
B.Tech Degree (Evening) Course-2012
8. Presently Employed in Kerala- Yes / No 10. Address for communication
11. Office Address
12. e-mail :
Please ensure that a valid e-mail ID is given and check the mail for future announcements
13. Qualifying Examination Details:
13(c) Marks obtained:- (aggregate marks obtained in all Semesters/years in the Diploma Examination) 14. Details of Experience after passing the qualifying examination
Total Eligible Service for weightage of marks: Yrs Months 15. Application Fee - Payment Details
`500 / 250
16. Institutional Preference
DECLARATION
(To be filled by the candidate)
………………………………………………………………….hereby solemnly and sincerely affirm that, the statements made and the information furnished in my application and in the enclosures thereof submitted by me are true to the best of my knowledge and belief. Should it, however, be found that any information furnished thereto isn’t tr ue, I realize that I am liable to criminal prosecution and agree to forgo my seat. Place:

Date:
PRESENT EMPLOYMENT & CHARACTER CERTIFICATE
CERTIFIED that, Shri/Smt…………………………………………………………….Son/daughter of shri/smt……………………………………………………………………………………………………….residing at .…………………………………………………………………………………………………………………………… ……………………………….(address) an applicant to B.Tech (Evening) Course is employed as ………………………………………………………………………………………………………….(designation) in ……………………………………………………( address of the firm ) from …………………………….till date. His/Her character is …………………………………. …………………………………………………………………………………………………… Check list for candidates: Please make sure that the following documents are
enclosed with the application before posting the same. No opportunity will be given to
incorporate any missing documents to the application in a later stage. Please put a √
mark
in the boxes concerned and send along with the application
Self attested copies of
Diploma/equivalent Degree certificate
Diploma/equivalent Degree mark list for all semesters/years Employment and conduct certificate from the present employer (in the form prescribed in the application form). Relevant page of S.S.L.C book or equivalent certificate in proof of age.
Originals of
Community Certificate, Nativity Certificate and Income Certificate for those
Experience Certificate to prove each claim in item No.14 of the application form. For claiming the weightage of marks for experience in Public/Pvt Ltd companies, relevant proof that your service in the company for the period comes under the purview of ESI or EPF must be attached. Such experience alone should be considered. Service certificate for Govt. Servants clearly indicating the tenure of service. Certificates in proof of the employment in public or private limited companies or establishments which come under the purview of ESI or EPF. (Copy of
Certificate of Incorporation duly attested by the head of the organization)

Relevant certificate to claim the seat reserved for physically challenged/Sports A Demand Draft of ` 500 (` 250/-for SC/ST) drawn from State Bank of
Travancore in favour of the Principal, College of Engineering, Trivandrum,
payable at Trivandrum
Ensure that your photograph is affixed and you have signed the declaration. Signature of the candidate
For Office Use Only
Received on--------------------by hand /by post Sl. No.-------------------
Branch:C/ M / E / T /R Category : G/SC/ST/PH/SP/OEC/SEBC/DT

Source: http://dtekerala.gov.in/downloads/btechappl.pdf

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