You are on page 1of 4

Gokhale Education Society's

N. B. Thakur Law College


Nashik - 422 005
ID No. : PU/NS/LAW/010/(1969)

APPLICATION FOR ADMISSION

Roll No. Checked By


To Be Filled in by the Office Paying Student ☐ AFFIX
Received Rs. Category: SC your
Receipt No. Admission For: DLL & LW Passport size
Date: recent
Photograph
Signature:
Account Section
(Application to be PERSONALLY filled in and signed in the college office by the Applicant)

To,
The Principal,
N.B. Thakur Law College, Nashik

Madam,
I hereby apply for admission to
DLL & LW
the
for the academic year 2018-2019. Kindly grant me admission to the said course. I give below information
regarding myself for your kind consideration.
Name (In Full) Shri. MOKAL JAYENDRA BHAUSAHEB
(IN BLOCK CAPITALS) Surname Name Father's/Husband's Name
Name In Devnagri Script

CET Seat Number CET Score

Place of
Date of Birth Taluka District State Male/Female
Birth
2/Dec/1987 NIPHAD NIPHAD NASHIK Maharashtra Male
Whether of BC or if BC or OBC give Race and
Married/Unmarried Mother Tounge
OBC Category Caste Sub Caste Religion
Other HINDU Unmarried MARATHI

Other languages known ENGLISH HINDI


Name (In Full of Father / Guardian) MOKAL BHAUSAHEB BELJAM

Page 1 of 4
Address of the
SUBHA BUNGLOW NEAR MARUTI MANDIR SHRIRAMNAGAR
Father/Guardian
Occupation of the
Tel. No. (If Any) 02532303562 RETIRED
Father/Guardian
Annual Income 300000

Applicant's Address at Nashik ADGAON NASHIK


SUBHA BUNGLOW NEAR MARUTI MANDIR
Applicant's Permanant Address
SHRIRAMNAGAR
Mobile No. 7798868818 Tel. No.(If Any)(O) (R) 02532303562

Last College Attended VISHWAKARMA INSTITUTE OF MANAGEMENT PUNE

Previous Marks Class


Month/Year University/Board %
Examination Passed obtained out of Obtained
HIGHER
MBA Jun/2012 PUNE UNIVERSITY 1604/2 57.29
SECOND
/

No Library Book with him/her


Remarks from the Signature of the
Previous Class Roll No. Academic Year
Librarian Librarian

I hereby agree, if admitted, to confirm to the rules and regulations at present in force or that may hereafter be
made for the governance of the College, and I undertage that so long as I am a student of the college, I will
do nothing either inside or outside the College that will interfere with its orderly governance and discipline. I
further declare that I shall not take part in any movement which is likely to be subversive of law and order.

I hereby submit to the disciplinary jurisdiction of the Vice-Chancellor and the other officers and authorities
of the university / and the authorities of the College and shall observe and abide by the rules made by the
Vice-Chancellor in that behalf / and, also by the rules that are in force at present or that may be framed
hereafter by the PRINCIPAL OF THE COLLEGE.

I understand that if admitted, my admission will be confirmed only on my production of the Transference
Certificate from the previous college/educational Institution. Or the Final Eligibility Certificate from the
University of Pune as the case may be.

I undertake to take an Identity Card Immediately and to carry it with me while in the College premises, and
to produce it as and when the relevant authorities demand.

I also undertake to submit within eight days the necessary application / documents in connection with the
Govt. concession to which I am entitled.

I am aware that the course for which I am seeking admission is a regular internal course, for which
attendance is compulsory.

Page 2 of 4
UNDERTAKING

I have read the Rules, Regulations regarding Discipline, Fee Structure etc, of the college, given in the
Prospectus and these are binding on me. I undertake to abide by the same. I know that the rules of discipline
etc. are to be followed in letter and in spirit and that any breach therof will entitle me for disciplinary action
including cancelling of admission / terms.

Witness: Yours faithfully,


Parent's
Signature:
Nashik - 422005 (Signature of the Applicant)
Date:

DECLARATION

(I hereby declare)
that my place of residence and employment* is within the jurisdiction of the University of Pune.
that the said place is within such radius from the college that I am in a position to attend the college
regularly.
that I am not employed.
that I am emplyed* by my working hours do not clash with the College working hours.
that I have obtained permission from my emplyer to undergo this course and to attend the college regularly
and that the said letter giving me permission is enclosed here with for the college record.
that I shall personally attend the College and complete the formalities needed for the grant of terms.

I have not taken admission in C.A.

Date: ____/____/2018
(Signature of the Applicant)
Warning : If a student gives false declaration, his/her admission is likely to be cancelled instantaneously.
Further, he/ she will be liable for such other punishment as prescribed by the college authorities.

DECISION OF THE PRINCIPAL

Admitted Provisionally. For formal completion of admission, production of T.C. from the College last
attended and Eligibility Certificate from the University of Pune, are absolutely essential.
To pay Rs. _________________________________________ (at the time of admission)

Nashik - 422005 Dr. Mrs. Asmita A. Vaidya


Date : ____/____/2018 Principal

Following documents must be submitted in the College Office alongwith the Application for Admission at
the time of admission

1) Statement of Marks of the qualifying Examination with its Xerox Copies


2) Copies of passing Certificate / Degree Cerificate.
3) Transfer Cerificate from the previous college with its xerox copies/Migration in original with its Xerox
copies.
4) Education Gap Certificate (Affidavit)

Page 3 of 4
5) Caste Cerificate.
6) Passing Cerificate of the Std. XII Exam with its Xerox copy.
7) Statement of marks of Std. XII Exam. with its Xerox copy.
8) For Pre-Lw Students.
9) Application for eligibility (Available in College Office with a fee chart.)
10) Two passport size recent Photograph.
11) The Tution fee for the students who are from outside the State of Maharashtra will have to pay double
the Tutuion fee and the Non-resident Indian student, person of Indian Origin, Foreign Citizen / Foreign
Nationals will have to pay five times the Tution fee that is prescribed for the students from the state of
Maharashtra. The student from SAARC except Pakistan and Bangladesh Countries will pay three times the
Tution fee as prescribed in Circular No. USG/1492/104201/(131/92)-UNI 3 dated - 22 July, 1994

Page 4 of 4

You might also like