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.