First Year Masters in Management Admissions 2017 Application Form

STATE COMMON ENTRANCE TEST CELL

305, Government Polytechnic Building, 49, Kherwadi, Bandra (E), Mumbai – 400 051 (M.S.)
Application Form for Admission to First Year of Post Graduate Technical Courses in Management for the Academic Year 2017-18

Application ID : MB17127789    Version No : 2

Personal Details
Candidate's Name YASH SHANTILAL JAIN
Father's Name SHANTILAL MOOLCHAND JAIN
Mother's Name MANJULA SHANTILAL JAIN
Gender Male
Date of Birth 08/03/1991
Candidature Type Maharashtra - Type A
Home University Mumbai University
Category Open
Category for Admission Open
Person with Disability Not Applicable
Belongs to Religious / Linguistic Minority Yes - Religious Minority - Jain
District from which Candidate has Passed HSC / Equivalent Examination Thane
District from which Candidate has Passed / Appearing for Graduation Thane
Application Fee Paid ( ) 1000/- Nationality Indian National
I, the holder of Aadhaar Number [489659730124], hereby give my consent to State CET Cell to obtain my Aadhaar number
Aadhaar Number for authentication with UIDAI. State CET Cell has informed me that my identity information would only be used for
admission purpose and will be submitted to CIDR only for the purpose of authentication.
Has Bank Account ? Yes
Account Number 504401011001208 IFSC Code VIJB0005044
Qualification Details
Qualification Marks Obtained Marks OutOf Percentage
SSC Mathematics 142.00 150.00 94.67
SSC Science 96.00 100.00 96.00
SSC English 68.00 100.00 68.00
SSC Aggregate 567.00 650.00 87.23
HSC Aggregate 517.00 600.00 86.17
Graduation 1087.00 1500.00 72.47
Graduation Status Passed Graduation Type Full-Time
Graduation Faculty Engineering / Technology Graduation Passing Year 2013
Graduation University Mumbai University
All India Exam Details
Sr. No. Examination Name Roll No Rank Total Score Percentile
1. MAH-MBA/MMS-CET 2017 6101094606 - 101 98.10
2. CMAT (Conducted by AICTE in 2017) 5440369406 960 255 98.38
3. CAT (Conducted by IIMs) 6220296 - 0 94.66
List of Documents Required at the time of Document Verification and Confirmation at Facilitation Center (Do not attach Xerox Copies)
Sr. No. Document Name
1. Certificate of Indian Nationality in the Name of the Candidate.
2. Domicile Certificate of the Candidate showing his / her Domicile State is Maharashtra.
Declaration of the Candidate for the respective Linguistic / Religious Minority Community in Proforma - O OR School Leaving
3.
Certificate having information pertaining to Religion / Mother tongue.
4. Statement of Marks or Certificate of Passing SSC / Equivalent Examination.
5. Statement of Marks or Certificate of Passing HSC / Equivalent Examination.
6. Statement of Marks or Certificate of Passing Graduation Examination.
7. Score Card of CMAT (Conducted by AICTE in 2017).
8. Score Card of CAT (Conducted by IIMs).
9. Cancelled Cheque of Bank Account.
Declaration
                    I have read all the rules of admission and on understanding these Rules, I have filled this Application Form for Admission to First Year of Post Graduate
Technical Courses in Management for the Academic Year 2017-18. The information given by me in this application is true to the best of my knowledge & belief. If
at later stage, it is found that I have furnished wrong information and/or submitted false certificate(s), I am aware that my admission stands cancelled and fees
paid by me will be forfeited. Further I will be subject to legal and/or penal action as per the provisions of the law.
Place :                                   Date : 26/05/2017
Printed On : 26/05/2017 12:23:12 PM
Last Modified On : 26/05/2017 12:16:53 PM Signature of Applicant
Last Modified By : MB17127789, 1.186.175.244 (YASH SHANTILAL JAIN )