APPLICATION NUMBER 7010535 PAYMENT MODE CREDIT CARD

COURESES/APPLIED ICAS (Mechanical AMOUNT 2000

Engineering)
ICAS (Mechatronics
Engineering)
DATE OF BIRTH 18/3/2001 DD NUMBER NA
SEX Male DD DATE NA
NATIONALITY India CATEGORY GENERAL
NAME OF THE APPLICANT Bhuvan sai
NAME OF THE PARENT/ Yasodhabai
GUARDIAN
ADDRESS FOR 8/125.sri nagar colony,rc roadplot 47,hanuman layouttirupathi
CORRESPONDENCE
PIN 517502
CITY Tirupati E-MAIL ADDRESS bhuvansai.sai@gmail. com
STATE Andhra Pradesh MOBILE NUMBER 918328222532
PARENT EMAIL yasodhabai631@gmail. PARENT MOBILE 9985807776
com
Class Institution Year Subject Marks
10th SPRING DALE PUBLIC SCHOOL 2016 Aggregate 82%
12th Narayana Sri Chaitnya Junior Collage 0 NA NA
NA NA
NA NA
NA NA
NA NA
Aggregate NA
Medium of Instruction English Optional Subject Chemistry

DECLARATIONS:
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I
have read and understood all provisions of admissions and agree to abide by them. I also affirm that I fulfil the eligibility
requirements for the course/s applied. In the event of submission of fraudulent, incorrect or untrue information or
suppression or distortion of any fact, like educational qualification, marks, nationality etc. I understand that my admission/
degree is liable for cancellation. I further understand that my admission is purely provisional subject to the verification of the
eligibility conditions.
NOTE:
1.Please keep a copy of the filled in application for future reference.
2.Application number must be quoted in all future correspondence.
3.Please send this completed application form with DD (if payment is not via Credit Card) to: Director Admissions, ICAS,
Manipal Academy of Higher Education, Madhav Nagar, Manipal – 576104’