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Registration

No:
(for Office use only)

Annes Academy
(An innovative training provider)
TN govt licence number: - 324/2013, dated: - 11/0/2013
865/1A2, Rajakrishnapuram PO, Levenchipuram Village,
Tirunelveli is!, Tamilna"u, P#$ % 62&11', #n"ia(
Application Form for Admission to IVQ Level III Advanced Diploma in
Oil & Gas Field for academic year 20! "atc# I $ II
%#oice of "ranc# (Tick as Applicable) :
!"# level !!! advanced diploma in Oil ) *as +iel"
1( Pr,cess Opera!i,n
2( -echanical -ain!enance
.( /lec!rical -ain!enance
'( #ns!rumen! -ain!enance
&e'istration Fee( 500 /- (By Cheque / Demand Draf dra!n in fa"#ur #f $Anne%s
Academy& Tamilnad 'ercanile Bank (d)* An+u,ramam)
"an) %#e*+e $ D,D, Date Amo+nt Iss+in' "an)
DETAILS OF THE CANDIDATE:
1. Name of the Candidate (Capital letters)
___________________________________________________
(First name followed by srname!
2. Candidate"s Address for
#orres$onden#e:_____________________________

_______________________________

______________________________

______________________________
Phone No.
:___________________________
E-ail
:___________________________
!. %ender: "ale#$eale Date&of&'irth:
-lease paste .do
not pin/
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%olo+r
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si,n acr#ss he
l#!er par #f he
ph##
Registration
No:
(for Office use only)
%. Name of the Father :
_____________________________
&. Name of the (other :
_____________________________
)* Details of +alified E,amination:
Name of
E,aminatio
n
Name - Address of the
S#hool. Colle/e
Name of the 'oard.
0ni1ersity
2ear of
$assin/
'. E,$erien#e: (if any)
(. Photocopies of the follo)ing *ocuents are to +e attache* )ith the
application
a. ,**ress Proof (Ration car* # -oter ./# ,a*har car* # /ri0ing
license)
+. /egree#/iploa Certificate.
c. $inal "ar1 2ist.
De#laration:
1* 'r/'rs) 22222222222222222222222222222222222222222222222222222s#n #f
'r/'rs) 22222222222222222222222222* hereby declare ha all he pariculars ,i"en in he
applicai#n and encl#sures are rue # he bes #f my kn#!led,e and belief)
Dae:
3lace: (4i,naure #f he Applican)
Registration
No:
(for Office use only)
FO& OFFI%0 120 O3L4
Applicai#n 5ecei"ed Dae : 22222222222222222222222222222222
5eceip 6#) : 22222222222222222222222222222222
'#de #f 3aymen : Cash / DD / 5T74
Demand Draf / 5T74 6# : 22222222222222222222222222222222
Demand Draf / 5T74 Dae : 22222222222222222222222222222222
6ame #f he Bank : 22222222222222222222222222222222
&eceived "y %#ec)ed "y
55555555555555555555 555555555555555555555555

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