Thiruvalluvar University - Serkadu, Vellore, Tamil Nadu, India

Name of the Bank

Place of the Bank

A/c. No

Date

Fees Paid

Name of the Student [IN BLOCK LETTERS]

Course of study with Main Subject - Degree

Subject

Period of study [First Year] From

Name and Address of the College where He/She is now studying the course

Language Paper/s offered by the College under Foundation Course [other than the Language paper to be opted by the candidate]

Language paper now opted by the student under Foundation Course [other than the above cited Language paper offered in the college]

Name and address of the College in which the Language Paper opted by the Student is now offered

Name, Designation and College Address of the Lecturer working in the above College under whom Private Tuition is undertaken by the student

Whether He/She has given His/Her Consent to offer Private Tuition to the student

Whether He/She is Qualified Teacher