Application Form No.

MCAER-UG14-000044
(For Application Receipt Center Use Only) PUN
Personal Information
Candidate's Name Mr. RAHUL ANANT MORE
Father's/Husband's Name ANANT RAHUL MORE
Occupation of
Father/Parent
AGRICULTURIST
Address and Contact No.
Mother's Name SAVITA RAMKRISHNA KADAM
Date Of Birth 01/07/1997
Domicile
Gender
Domicile Option
Domicile State(Only For
Out of Maharashtra
Candidate):
Signature
Photo
Category & Application Receipt Center Details
Application Receipt
Center (ARC )
KALP TECHNLOGIES PVT. LTD,
SHOP 1 & 2, RADHAKANT CO-OP. HSG. SOCIETY, RAMBAUG COLONY, OPP.KRISHNA HOSPITAL, PAUD ROAD,
PUNE 411 038, PUNE,
PUNE, 411038
Category SC
Whether belongs to
economically backward
class
Yes
Original
Category
SC
Other Reservations AG Non Creamy Layer
KUMBHAR
BY RESIDENT MAHARASHTRA
MALE
No
Caste
This is Preview of your application form. Please don't take the print
out of this.You have to take print out post submission of Payment.
Application Help Centre Code
Sub Caste KUMBHAR
Passport Size Photo
Dimensions
(4.5cm X 3.5cm-1.78"
X 1.38")
1 Out Of 5
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Form Printed on : 6/2/2014 10:40:29 AM
H4,AKSHAY SOCIETY
MAIN ROAD,
City : NAGAR, Pincode : 414123.
Taluka : RAHATA, District : AHMEDNAGAR,
State : MAHARASHTRA,
Phone No : ,Mobile No : 9637621214,9822012345
Email : rahul.m1997@gmail.com
Academic Details
SSC Percentage 56.66 HSC Exam Seat No. H349490
Name & Address of HSC
passed
RAHATA VIDYALAYA,City:RAHATA,
District:AHMEDNAGAR,State:MAHARASHTRA
Month & Year of Passing 06/2013
Total No. of
Attempts
1 Faculty SCIENCE
Marks in HSC / Diploma
(Max Marks)
Subject wise Marks
Physics Chemistry Biology Maths English
45 / 100 65 / 100 45 / 100 76 / 100 54 / 100
Code of Optional Subjects
Vocational Subject Codes
600
(Marks Obtained)
456
(Percentage)
56.66
Weightage Details
Sr.
No.
Weightages
B.Sc.
(Agri)
B.Sc.
(Hort)
B.Sc.
(Forestry)
B.F.Sc.
B.Tech.
(Engg)
B.Tech.
(Food
Tech.)
B.Sc.
(Home
Sci.)
B.B.A(Agri)
B.Sc.
(Agri.Bio)
Village form 7/12 extract /
Khasara for the year 2011-12
or 2012-13 issued by the
Talathi / Patwari
Certificate of Landless
Agricultural Labour issued by
the Tahasildar / Naib
Tahasildar.
Certificate of Fisherman
issued by Tahasildar / Naib
Tahasildar
Certificate Of Agriculturist
issued by the Tahasildar / Naib
Tahasildar
1
2
3
4
5
N.C.C. B or C Certificate ( Air /
Naval / Army wing) issued by
the Commandant (Passed
during XI or XII Standard).
6
N.S.S. Certificate of 240 hrs. /
N.S.S. Special Camp issued by
the competent authority.
7
Employers Certificate being
son / daughter of Agricultural
University / MCAER employee.
8
Certificate of Diploma in
Agriculture Science of Rural
Institute Amaravti or Wardha.
9
Certificate of Diploma in
Agriculture School.
10
Sport Certificate(International /
National / State / District) Level
11
Academic Points (Percentage)
12
Weightage Points
13
Total Points
14
Eligible For Course
Certificate of Debate / Essay /
Elocution of state Level
Competition issued by
concerned Organisation.
15
16
17
18
12
0
0
0
0
0
0
0
0
0
56.66
12
68.66
Yes
0
0
0
0
12 12 12 12 12 12 12 12
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
56.66 56.66 56.66 56.66 56.66 56.66 56.66 56.66
12 12 12 12 12 12 12 12
68.66 68.66 68.66 68.66 68.66 68.66 68.66 68.66
Yes Yes Yes Yes Yes Yes Yes Yes
Application Form No MCAER-UG14-000044
2 Out Of 5
B.Sc.
(Animal
Husbandry)
12
0
0
0
0
0
0
0
0
0
0
0
0
0
56.66
12
68.66
Yes
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Form Printed on : 6/2/2014 10:40:29 AM
Document Details
S.S.C . (X std.) Mark sheet / Statement of marks.
H.S.C . (XII) std. or Diploma Mark sheet / Statement of marks.
College Leaving/ Transfer Certificate (last attended)/ Bonafide certificate of the college where admission has already been taken.
The candidate admitted in last academic year in any Agricultural University in Maharashtra if again applies to seek the admission for the current
academic year for the first year degree course, then the Bonafide Certificate issued from the last attended respective College/Institute will be
considered.
(i) Village form 7/12 extract / Khasara for the year 2012-2013 or 2013-14 issued by the Talathi / Patwari showing that the land is in his/her name
or in the name of parents/ grand parents.
(ii) In case parents are not alive, the 7/12 extract should be in the name of his/her brother/ paternal uncle and the candidate must attach an
affidavit on stamp paper of Rs.100/- (One Hundred only) of the land holder stating that the applicant has legitimate share in the land.
(iii) In case the extract is not in Marathi/Hindi or English, a certified translation should be attached.
(iv) Affidavit submitted by mother of the Candidate of her father on stamp paper of Rs.100/- (One Hundred only) stating ancestral land in her
name alongwith 7/12 extract thereof.
NCC B or C Certificate ( Air/ Naval/ Army wing) issued by the Commandant (Passed during XI or XII Standard).
Certificate of Landless Agricultural Labour issued by the Tahsildar/ Naib Tahsildar stating that the principal means of livelihood of the parent is
manual labour on agricultural land. (This certificate should not be in the name of applicant.) However, Agriculturist (AG) category will not be
given to Landless Agricultural Labour.
Certificate of Fisherman issued by Tahsildar / Naib Tahsildar stating that the source of income is from fishing only.
NSS Certificate issued by the competent authority in respect of Jr. College or Students Welfare Officer or Programme coordinator for
admission to under graduate courses.
Certificate of participation in Sports/ Games issued by the District Sports Officer that the applicant has participated the College at XI and / or XII
Std. in International, National, State, District competition.
Mark sheet/Certificate of Diploma in Agriculture Science of Rural Institute Amaravti or Wardha.
Migrant/ Displaced Students from Jammu and Kashmir State should submit Certificate from the competent authority as mentioned in
Government Resolution No. AGU-2095/23106/CR-181/19-A, dated 5/9/1996. Affidavit regarding displacement will not be entertained.
Employers Certificate being son/daughter of Agricultural University/MCAER employee.
Certificate of Debate / Essay/ Elocution issued by the District Sports Officer that the applicant has represented the Institute at XIth and / or XIIth
Std. in District, State, National, International level tournaments.
Domicile Certificate or Birth Certificate issued by the Competent Authority OR School Leaving Certificate containing place of birth for
Maharashtra and other State candidates too.
Caste Certificate issued by competent Authority designated in the State.
Caste Validity Certificate issued by the Competent Authority.
Non Creamy Layer Certificate valid as on date of admission.
Whether the Certificate of the Freedom Fighter issued in favour of parents/Grand parents of the Candidate is issued under the signature of the
Hon. Prime Minister/Chief Minister, Maharashtra State.
Certificate of Defense Personnel (DP) issued by the Zilla Sainik Welfare Officer/Discharge Certificate issued by the Officer Commanding the
Regiment or Serviceman Certificate issued by the Competent Authority.
Certificate of Physically Handicapped (PH) issued by District Civil Surgeon or equivalent Government hospital/ Medical board.[The percentage
of disability shall not be less than 40% in case of candidate seeking reservation for physically handicapped category.]
Certificate of Project Affected Person (PAP) issued by District Resettlement Officer/ Rehabilitation Officer of Government of Maharashtra in the
prescribed form that his/her parents/grand parents land has been acquired by the Government for Agricultural University/ Irrigation/ Power/
Defence Project having the name of beneficiary.
Certificate of Agriculturist (AG) issued by the Tahsildar/ Naib Tahsildar showing that the applicant or his/her parents or grand parents (Paternal)
is/ are owner or tenant, holds agricultural land and whose main source of income is derived from personal cultivation of land.
Mark Sheet / Certificate of Diploma in Agricultural Technical School.
Economical Backward Class (EBC) Certificate issued on or after 1st January,2014 issued by the concerned Tahsildar.(This provision is only for
the students admitted through centralised admission process in non grant Colleges.)
No objection Certificate from employer if employed .
Undertaking in Appendix J regarding cleanliness habits
Application Form No MCAER-UG14-000044
Mark Sheet / Certificate of Diploma in Agricultural Engineering from Jammu and Kashmir state.
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Name of the ARC representative:
(Sign of ARC representative)
6/2/2014 10:40:29 AM
3 Out Of 5
Form Printed on : 6/2/2014 10:40:29 AM
I hereby declare that I have checked all the documents enclosed with the Application Form against the values entered by the applicant in
the online application form. I have recorded my observations in the system.
Change in any of values entered by the student is not required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - OR - - - - - - - - - - - - - - - - - - - - - - - - - - -
I hereby notify Kalp that as the value/s entered by applicants and those in the submitted documents do not match following values should be
modified as per the documentary proof:
Marks Category Home University Any other
- - - - - - - - - - - - - - - - - - - - - - - - - - - For office use only - - - - - - - - - - - - - - - - - - - - - - - - - - -
College Options Details
Application Form No MCAER-UG14-000044
4 Out Of 5
[1]-(11101) | [2]-(11102) | [3]-(11103) | [4]-(11104) | [5]-(11105) |
I hereby declare that all the information furnished by me in this Application Form is true and complete to the best of my
knowledge and belief. I understand that entries made by me in this Application Form are final and binding on me. I
further declare that in the UG Admission Process if any information being found false or incorrect I shall be liable for
action taken by MCAER.
Declaration
Place :
Date :
(RAHUL MORE)
Print Date : 6/2/2014 10:40:29 AM
Signature of Candidate
Payment Details
Note : Example to read [Preference No1]-(College Code 1) | [Preference No2]-(College Code 2)
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Payment Type
Amount
Branch
Bank Name
DD Number
02/06/2014
Date
:
:
:
:
:
:
:
Application Date
To:
KALP TECHNLOGIES PVT. LTD,
SHOP 1 & 2, RADHAKANT CO-OP. HSG.
SOCIETY, RAMBAUG COLONY, OPP.KRISHNA
HOSPITAL, PAUD ROAD, PUNE 411 038,
PUNE, Pincode : 411038
PUNE.
Print Date : 6/2/2014 10:40:29 AM
From:
RAHUL MORE,
H4,AKSHAY SOCIETY
MAIN ROAD,
NAGAR, Pincode : 414123
RAHATA,AHMEDNAGAR,
MAHARASHTRA.
Please cut this section and paste it on Envelope to be sent to ARC Center.
MCAER-UG14-000044
5 Out Of 5