Applicationform

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  • Topic: Maharashtra, Mumbai, Ramrao Adik
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  • Published : December 6, 2011
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Application Form
Please Paste Pasport Size Photograph

Application Number Appilcation type
Student SSC Details

APP5533111200000030 New Renewal Course Year N.A

SSC Board Passing Year
Applicant's Details

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION 2009 SSC Seat No A276644 SSC Marks Obtained 75.69

Applicant Name Date of Birth

AKASH
first name

RAJU
middle name

PANTAVANE
last name

Mother's Name Is Resident of Maharashtra Application Date

MANDA Maharashtra

07-02-1994

Gender

Male

Academic Year Caste Category Caste Orphan Is Applicant Salaried ? Maritial Status

2011-2012 Scheduled Caste Mahar (37) No No Is Disabled Applicant's Annual Income Is Staying at Hostel ? Sub Caste No 0.00

02-10-2011

Disability Type

N.A. 50000.00

Total Annual Income Has Applied For Hostel ?

No

No

No

Student Prequalifying Details

Last attended School/College/Institute Last Exam Passed Passed Institution Details

Bahvans Junior College Last Exam Passed Year 2011 Last Exam Marks 44

HSC Yes

Name of School/College/Institute where Admitted Course Name Subject College Admission Number Is Fees Paid ? Fee Receipt Date

Ramrao Adik Education Society's Ramrao Adik Institute of Technology,Nerul, Navi Mumbai-400706

Bachelor of Engineering (ENTC) ENTC 11ET1103 Is Admission after Diploma Date Of Admission Fee Paid Course Year No 24-08-2011 Academic Year Joining Date 2011-2012 26-08-2011

No

0.00 1

Fee Receipt No. Quota Government Quota

Contact Details

Residential Number: N.A, MobileNumber: 9833464211, EmailAddress: N.A

Address For Correspondence

Address:- Shree Ganesh Society, Sunder Nagar, Tunga Village, Saki Vihar Road, Powai - 400072 Location:- Mumbai City:- Sakinaka Pincode:- 400072 Taluka:- Mumbai(Suburban) District:- Mumbai(Suburban)

Parent / Guardian Details

Parent's name

RAJU
first name

Wamanrao
middle name

PANTAVANE
last name

Relation with Applicant Parmanent Address

Father

Parent Age

47

(yrs)

Profession

Others

Shree Ganesh Society, Sunder Nagar, Tunga Village, Saki Vihar Road, Powai - 400072

Parents Annual Income

50000.00

Hostel Information

Name of Landlord / Hostel Hostel Type

N.A

Hostel Admission Date Is Mess Service Available? No Rent Per Month

N.A

N.A

Hostel/ Landlord Address

N.A

Hostel/Landlord Contact Details

N.A

Is Studying in night school
Document Details

No

Caste Certificate No Caste Validity Certificate No Income Certificate No University Registration No

G5559/1999

District Issuing Office District Issuing Office Issued in

Mumbai(Suburban)

Taluka Issuing Office Scrutiny Committee No

Mumbai(Suburban)

21228

Mumbai(Suburban)

6479

2011

Student Bank Account Details

Bank Name Branch Name

CORPORATION BANK MUMBAI-VERSOA

Bank Account No

SB01092664

Document Attached

Caste Certificate Issued by Competant Officer Income Proof - Income Certificate Issued by Competant Authority Marksheets I-card Size Photo Caste Validity Certificate District Transfer Certificate

Declaration

The information furnished by me is complete and correct. I bear the complete responsibility for all the above information.

Applicant's Signature

Applicant Parent's Signature

Principal's Signature

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