SIR SYED INSTITUTE
FOR TECHNICAL STUDIES
P.O. KARIMBAM, TALIPARAMBA PIN 670142
Ph : 0460/2209381, 2200128
website:www.sirsyedinstitute.com
APPLICATION FOR ADMISSION TO BBM/ B.Com/ B.Sc /M.Sc DEGREE COURSE
I CHOICE ……………………………
II CHOICE……………………………
1.Name in BLOCK Letters
( As in SSLC Book)
2.Address to which communications are to be sent
Phone No with code:
3. Age & Date of Birth in figures and words
4. Sex/ Nationality/ Religion
5. Caste
6. Do you belong to SC/ST/OBC/OEC
if YES give the name of the Community
7. Details of NSS/NCC/SPORTS/ARTS/
any other extra curricular activities
8. Are you dependent on Ex- Service man
If YES give details
9. Name of School/College and location from
where you passed the qualifying Examination.
11. Percentage Marks in SSLC = +2 = Degree =
12. Did you discontinue your studies? If YES
Give reasons
13. Second Language for Degree course
under Part II HINDI / MALAYALAM
14. (a) Name of Guardian with Address & Phone No.
(b) Name of Father
(c) Name of Mother
(d) Annual income
15. DETAILS OF QUALIFYING EXAMINATION
1. Name of Examination
2. Reg. No, Month and Year of
Examination
3. Name of Board /University
4. No of chances
16. DETAILS OF MARKS OBTAINED IN QUALIFYING EXAMINATION
MARKS MAXIMUM
SUBJECTS
AWARDED MARKS
Part I ENGLISH
Part II SECOND LANGUAGE
Part III OPTIONALS
1
2
3
4
5
TOTAL
DECLARATION
I declare that the all information furnished in my application are true to the best of my
knowledge and belief. I also declare that I shall abide by the rules and regulations of this
institution.
Place Name & Signature of Name & signature
Date Parent/ Guardian of Applicant
FOR OFFICE USE ONLY
1. Marks Checked by :
2. Date of Admission :
3 .Class to which admitted :
Signature of Principal
Note: Application Fee Rs.100 to be remitted in the office at the time of submission.