8/9/2019 Dde Regular

1/2

Others (specify)

SC

1. Programme

Code & Name

Double Degree Programme Lateral Entry/Direct II / III Year Programme

2. PCP Zone (See Prospectus) Medium: English Tamil

3. OPTIONAL SUBJECT CHOSEN : (See Prospectus)

Preparatory, Pre-Foundation Programmes:

U.G. Programmes : Part-I :

Optional Papers: I Year: II Year: III Year: P.G. : I Year: II Year:

Programmes (optionals)

PASSPORT SIZE

PHOTO

duly signed

and attested

by an authorised

officer

APPLICATION NO.

SPOT CODEENROLMENT NO.

FOR OFFICE USE ONLY

ANNAMALAI UNIVERSITY

DIRECTORATE OF DISTANCE EDUCATION

Reg. No.

and Year

%

of Marks

Class

Obtained

Name of the

Examination

Name of the

University/Board

Duration of

Programme

(REFER PROSPECTUS FOR DETAILS) (Make a tick-mark ( ) in square wherever applicable)

Application Fee ` 100/- in person and 150/- by post.`

Application for Admission to

Preparatory / Pre-Foundation / Certificate /

Diploma / P.G. Diploma / Under Graduate /

Post Graduate / Double Degree Programme

including Lateral Entry 2014 - 2015

7. Date of birth (in the Christian era)

(as entered in the School Leaving Certificate)

8. Sex: Male Female 9. Nationality:

10. Religion: Hindu Muslim Christian

Date Month Year

91

11. Community :

13. Qualifying Examination Passed:

4. Name in CAPITAL LETTERS (In English):

6. ADDRESS IN CAPITAL LETTERS (to which communications and lessons are to be sent)

Dist.

State

PIN

E-mail ID Mobile No. :

5. Fathers Name / Husbands Name

Dist.

StatePhone No.

(with STD Code)

PIN

12.Differently Abled: YES NO Blind Others

Main :

Ancillary :

Percentage

Part - I Part - III

SCA ST MBC BCMBC OC DNC

8/9/2019 Dde Regular

2/2

14. Pattern of passing 11+1+311+2+2 10+2+3

(Direct OUS UG & PG Degree are not Eligible)

the Degree Examination:

15. Occupation : GovernmentNon-GovernmentOthers

16. Are you presently undergoing any

other programmes, in any institution Yes No (including DDE)? If yes, give details :

Place:

Date: Signature of the Applicant

Enclosures: (1) Photostat Copy of

(Check List)

Degree Certificate/Pass / Provisional Certificate(2) Copy of Mark List or Consolidated Mark ListPhotostat

(3) Copy of Transfer or Migration CertificatePhotostat

(4) Identity Card duly filled in

(5) Photostat Copy of Community Certificate

(6) Scanning Slip

(7) Community Certificate

(except OC)

(Do not enclose original certificates)

Official-in-Charge Section Head

Signature of the Candidate

i) I declare that the particulars given above are correct and I submit myself to the disciplinary and regularly jurisdiction of the authorities of

the University who are vested with the rights to exercise discipline under the Act, the Statutes, and the Ordinances, and will strictly observe

the rules and regulations that have been framed thereunder by the University.

ii) I hereby agree that with regard to disputes arising in all matters including admission, returning of original certificates after verification,

sending of lessons, PCPs, response sheets, examinations, remittance of fees, etc., only the Courts and Tribunals having jurisdiction over

Annamalainagar (Chidambaram), Cuddalore District, Tamilnadu and not over any other place, shall have jurisdiction for the purpose of filing a

suit or preferring complaint under the Consumer Protection Act or any other law for the time being in force or for taking any legal action against

the Directorate of Distance Education or the Controller of Examinations, Annamalai University.

DECLARATION

REMITTANCE PARTICULARS

2) Transfer OR Migration Certificate Draft/Challan Number :

3) Mark List (10th/12th Standard) Amount :

FOR OFFICE USE ONLY ELIGIBLE NOT ELIGIBLE

Provisionally selected for admission. Spot selection subject to confirmation by the Director

Name of the Bank :1) Degree/Provisional/Pass Certificate

Date :4) 8th Standard Transfer Certificate

5) 10th Standard Transfer Certificate

CERTIFICATES VERIFIED

Whether Original Certificate/Mark Lists Whether Lessons received NoNo received after verification? Yes If yes, Complete set Incomplete set

For use in Spot Admission

Yes

Official-in-Charge Section Head DIRECTOR

Admission Confirmed

Officer-in-charge

17. Option for Study Material: Hardcopy Softcopy