Thiruvalluvar University - Serkadu, Vellore, Tamil Nadu, India

Name Of The College

Course To Which Admitted & Year

Name Of The Bank

Place Of The Bank

A/c No

Date

Fees Paid

Name Of The Candidate (In BLOCK Letters) As Per Pass Certificate

Name Of The Father Or Guardian

Date Of Birth (As Per S.S.L.C Book Or Transfer Certificate)

Age - Years

Months

Sex

Name Of The Degree (UG/PG)

Main Subject

Academic Year In Which Joined

Whether Studying In Regular Or Evening College

Period Of Study

Name Of The College In Which He/She Has Been Admitted

Details Of The Eligibility Certificate Obtained

	Details of SSLC / GCE (Ordinary Level) or its equivalent qualifications i.e., 10^th or 11^th Std	Details of PUC / HSS / Intermediate / Pre-Degree / SSC / ISC / GCE Adv. Level or its equivalent qualifications	Details of B.A / B.Sc / B.Com / B.Ed / B.P.Ed etc. or its equivalent qualifications	Details of M.A / M.Sc / M.Com etc. or its equivalent qualifications
Name of the Examination Passed
Name of the School / College
Name of the Board / University
Register No.
Month & Year of Passing
Whether passed under Regular / Open University / Correspondence / Private Study
Total No. of Academic Years Studied	10 Years / 11 Years	1 Year / 2 Years	3 Years	2 Years
Passed / Failed
Name of the School / College
Max. Marks Prescribed for Pass
Total Marks Secured
Percentage of Marks