Travancore Medical College

Name of the Applicant (as shown in certificate)*

DOB

Age

Gender Male Female Other

Nationality

Caste, Religion and Community

Name of Parent

Relationship

Communication Address

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Category other than open merit, if any, to which the applicant desired to be considered.(see clause I b of the prospectus)

Document attached in support of claim in previous column.

Name of qualifying examination

Reg. No. & Year of passing.

Whether eligible for higher studies (Plus Two)

Name and address of institution last studied

Marks obtained at the qualifying examination

Part I

Mark Secured

Max. Marks

Percentage

Part II Aditional Language

Mark Secured

Max. Marks

Percentage

Part III OPtional Subjects

Subject 1

Mark Secured

Max. Marks

Percentage

Subject 2

Mark Secured

Max. Marks

Percentage

Subject 3

Mark Secured

Max. Marks

Percentage

Total for Physics, Chemistry & Biology/Biotechnology

Subject 4

Mark Secured

Max. Marks

Percentage

Subject 5

Mark Secured

Max. Marks

Percentage

Total Marks

Total Secured

Total Max. Marks

Total Percentage

Marks obtained at CBSE – National Eligibility Cum Entrance Test (UG)- 2016

Name of State

Roll Number

Maximum Marks

Marks Secured

Percentile Score

We, the applicant and his/her parent do hereby solemnly affirm that the statements made and information furnished in the application above and also in all the enclosures thereto submitted are true to best of our knowledge, belief and understanding. We declare that, the applicant will, if admitted, abide by the stipulations in the prospectus, code of conduct and rules and regulations of Travancore Medical College, Kollam.

Date

Place

Details of Registration fees

DD No.

Amount

Date

Bank

Bank Branch

Checklist of documents attaching with hardcopy of Application form

1. Crossed Demand draft for Rs 1000/- drawn in favour of ‘Principal, Travancore Medical College, Kollam’.

2. SSLC/10 th Standard certificate.

3. Proof of date of birth (if date of birth is not furnished in SSLC/X standard certificate).

4. Plus Two or equivalent certificate

5. Mark list of qualifying examination (Plus Two or equivalent).

6. Admit card of the National Eligibility cum Entrance Test of 2016 conducted by the Central Board of Secondary Education, New Delhi.

7. Mark list of the National Eligibility cum Entrance Test of 2016 conducted by the Central Board of Secondary Education, New Delhi.

8. Document/certificate from the authority, mentioned in the Prospectus, to establish the claim for reservation /privilege, if any, made in the application vide clause 1b of the Prospectus.

9. Community and Non-creamy layer/ income Certificate from Tahsildar / Village Officer in case the candidate requires relaxation in marks as per rules in force.

10. Course and Conduct Certificate from the institution last attended.

11. Declaration form filled by the Sponsor (For NRI Quota ).

12. Copy of Employment certificate/Visa copy of the Sponsor attested by Indian Embassy/Consulate ( For NRI Quota ).

13. Copy of relevant pages of Pass-port of the sponsor ( For NRI Quota)..

14. Copy of Certificate showing relationship of the applicant with the Sponsor issued by the Village Officer (For NRI Quota ).

15. If applying for both General and NRI management seats whether additional DD for Rs 1000/-required to be produced is attached.

Details of additional DD

DD No.

Date

Bank

Bank Branch

Enter Code:

1. All columns should be filled in by the applicant. If details required in a column is not relevant, Please mark it as 'Not Applicable' or 'NIL'.

2. Please note your Application ID sent to your email for future reference.