Application Form

Printed on Course 10/18/2013 9:54:47 PM Bachelor of Commerce GOI Post Matric Scholarship , 2013-2014 Other Backward Class

Application Number Appilcation type Student SSC Details SSC Board Passing Year

APPOPE0146864O200720 13 Renewal

Renewal Course Year

2011

Please Paste Passport Size Photograph

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION 2007 SSC Seat No OPE014686 SSC Marks Obtained 35.00

Applicant's Details Applicant Name BALAJI Date of Birth 27-11-1991 SOPAN Gender Maritial Status YELGATTE Male No Mother's Name ARCHANA

Is Resident of Maharashtra Maharashtra Caste Category Sub Caste Other Backward Class

Application Date 11-10-2013 Caste Orphan Kunbi (83) No

Is Disabled Applicant's Annual Income

No 0.00

Disability Type

N.A.

Is Applicant Salaried ? NO Is Staying at Hostel ? No

Total Annual Income 45000.00 No

Has Applied For Hostel ?

Student Prequalifying Details

Academic Year Institute Course Course Year Percentage Result

2012 - 13 2011 - 12 2010 - 11

B.N.N. COLLEGE BHIWANDI B.N.N. COLLEGE BHIWANDI B.N.N. COLLEGE BHIWANDI

Bachelor of Commerce Bachelor of Commerce Bachelor of Commerce

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44.00 37.85 29.00

ATKT Pass ATKT

Institution Details Name of School/College/Institute where Admitted Course Name Course Year EID Number Subject College Adm.No FTYBCM1778 Is Fees Paid ? Fee Receipt Date Contact Details No N.A Academic Year Admission Dt. Fee Paid GrantType 2013-2014 22-06-2013 0.00 Non Granted Is Admission after No Diploma Joining Date 22-06-2013 Fee Receipt No. Quota Government Quota B.N.N. COLLEGE, (ARTS, SCIENCE & COMMERCE) BHIWANDI

Bachelor of Commerce 3 CAP Number N.A UID Number 713840125986

Residential Number: , MobileNumber: 9270877768, EmailAddress: Address For Correspondence Address:- BHISE CHAWL Location:- City:- NA Pincode:- 421302 Taluka:- Bhiwandi District:- Thane 1 Of 2

Parent / Guardian Details Parent's name SOPAN GUNDIBA YELGATTE Age Profession 65(yrs) Service

Relation with Applicant Father Parmanent Address Is Father Alive Hostel Information Name of Landlord / Hostel Hostel Type Hostel/ Landlord Address Is Studying in night school Document Details Caste Certificate No Caste Validity Certificate No MHTHBH/19426/20 District Issuing Thane 08 Office N.A District Issuing N.A Office Issued in 2013 No Is Mess Service Available? No

BHISE CHAWL Location:- City:- Bhiwandi Pincode:- 421302 Taluka:- Bhiwandi District:Thane Annual Income 45000.00 Yes

Hostel Admission Date Rent Per Month Hostel/Landlord Contact Details 0.00

Taluka Issuing Office Scrutiny Committee No University Registration No

Bhiwandi N.A N.A

Income Certificate MAG/SR/4535 No Student Bank Account Details Bank Name Branch Name IFSC Code VIJAYA BANK

Bank Account No MICR Code

505801121002410

BHIWANDI,MAHARASTRA VIJB0005058 400029040

Document Attached Caste Certificate Issued by Competant Officer Income Proof Income Certificate Issued by Competant Authority Marksheets I-card Size Photo SSC Mark Sheet UID document xerox Declaration The information furnished by me is complete and correct. I bear the complete responsibility for all the above information. Applicant's Signature Principal's Signature _______________________ _______________________ Applicant Parent's Signature _______________________

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