Southern College of Engineering&Technology

Name of Applicant (As per Birth Certificate/S.S.L.C.Book

Father's Name

Permanent Address

Mailing Address

Telephone No.

Date of birth

(dd-mm-yyyy)

Place of Birth

Gender

MALE FEMALE

Whether Indian

Yes No Name of the Country

Examination Records

Examination	Exam Authority	Subjects	% of Marks

Attach Photograph

DD/IPO/ Bank Receipt No for an amount of Rs. 500/850 to be attached with this form, towards (Non – refundable) Application Registration Processing Fee.

Other Merits, if any of the applicant

Signature of the Applicant

Date of Submission of the form

Before filling in the application forms, verify and ensure the eligibility criteria prescribed for Indian / Foreign nationals.

This form should accompany two attested photocopies of each certificate, to prove age, educational qualification and 5 passport size photos, a self addressed stamped envelop and a registration fee of Rs.500(for Indian Students)Rs.850 for (Foreign Students)

DECLARATION

a.	All the entries made in this form are correct to the best of my knowledge and nothing material has been concealed by me.
b.	I shall abide by all the rules, regulations and standing orders of the institution that are in force and that will be made herein after. Incase I am found guilty, the authorities may take any action against me, inclusive of expulsion from the institute.
c.	I shall pay all my dues on time and shall not claim any refund for any reason whatsoever.
d.	I know any fees/dues/charges paid by me are neither refundable nor transferable.
e.	I possess a good moral character and I am not involved in any criminal case.
f.	I do not stand debarred from any public examination.
g	I shall not take part in any activity, which is detrimental to the discipline of the institute.
h.	All disputes are subject to the jurisdiction of Chalakudy Courts only.