GOVERNMENT OF PUDUCHERRY
Dr. B. R. AMBEDKAR POLYTECHNIC COLLEGE, YANAM
FOR THE ACADEMIC YEAR 2025–2026
PONDICHERRY INSTITUTE OF POST-MATRIC TECHNICAL EDUCATION (PIPMATE)

APPLICATION FOR ADMISSION TO DIPLOMA COURSES
PHOTO

APPLICATION NO: BRAPTC/2025-26/__________

I YEAR ADMISSIONS LATERAL ENTRY (II YEAR) ADMISSIONS
CIVIL ENGINEERING

ELECTRONICS AND COMMUNICATION ENGINEERING

COMPUTER ENGINEERING 		CIVIL ENGINEERING

ELECTRONICS AND COMMUNICATION ENGINEERING

COMPUTER ENGINEERING

2 NAME OF THE CANDIDATE *
(IN CAPITAL LETTERS – Required)
3 FATHER’S NAME / MOTHER’S NAME / GUARDIAN’S NAME
4 DATE OF BIRTH (AS PER SSC)
5 PERMANENT ADDRESS WITH MOBILE NO
6 ADDRESS TO WHICH COMMUNICATION IS TO BE SENT AND MOBILE NO
7 GENDER MALE / FEMALE / OTHERS
8 E-MAIL ADDRESS
9 AADHAR CARD NO
10 COMMUNITY O.B.C / M.B.C / S.C / B.T / B.C.M / E.B.C
11 NATIONALITY INDIAN / OTHERS
12 RELIGION HINDU / CHRISTIAN / MUSLIM / OTHERS
13 HAVE YOU SERVED IN N.C.C FOR MORE THAN 2 YEARS WITH 75% ATTENDANCE? YES / NO
14 MENTION SPECIAL QUOTA F.F / P.H / EX-SER / SPORTS / NONE
15 MENTION REGION YANAM / ANDHRA PRADESH / OTHERS

PARTICULARS OF QUALIFYING EXAMINATION PASSED
A NAME OF THE QUALIFYING EXAMINATION SSC / MATRIC / 12th / ITI
B MONTH AND YEAR OF PASSING
C NUMBER OF ATTEMPTS
D TOTAL MARKS OBTAINED OUT OF

DECLARATION BY THE APPLICANT AND PARENT/GUARDIAN

I __________________________ Son/Daughter of __________________________ declare that the above information is true.

PLACE: ____________
DATE: ____________

SIGNATURE OF THE APPLICANT


SIGNATURE OF THE PARENT/GUARDIAN


List of Enclosures

10th MARK LIST ORIGINAL & 3 XEROX COPIES
10th T.C & 3 XEROX COPIES
LATEST RESIDENCE CERTIFICATE & 3 XEROX COPIES
LATEST COMMUNITY CERTIFICATE & 3 XEROX COPIES
AADHAR 3 XEROX COPIES
PASSPORT PHOTOS (RECENT)