Maritial Status No Caste Agari (169) Sub Caste Is Applicant No Salaried ? Applicant's Annual 0.

00 Income Total Annual 55000.00 Income MMS FIRST YEAR 2011 65 C. K. THAKUR INSTITTUTE OF MANAGEMENT STUDIES & RESEARCH, NEW PANVEL Last Exam Passed Last Exam Marks Year Last attended School/College/Institute Last Exam Passed Master of Management Studies HUMAN RESOURCE 2011-2012 04-07-2011 04-07-2011 Government Quota Is Fees Paid ? No Quota Academic Year Date Of Joining Date Admission Subject Course Name first name middle name last name SSC Seat No E124595 SSC Board MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION Passing Year 2004 Fee Receipt No. Fee Receipt Date SSC Marks Obtained 62.00 Student SSC Details Applicant's Details Orphan No Has Applied For No Hostel ? Please Paste Pasport Size Photograph Student Prequalifying Details Institution Details Academic Year 2011-2012 College Admission 46 Number Application Form Caste Category Other Backward Class Appilcation type Renewal Application Date 08-10-2011 Applicant Name ARATI DATTATREY THOMBARE Mother's Name DIPALI Is Resident of Maharashtra Date of Birth 02-10-1988 Gender Female Maharashtra Name of School/College/Institute where

Admitted C.K.T Institute of Management Studies & Research New Panvel Is Staying at Hostel ? No Disability Type Fee Paid Course Year Passed 0.00 2 Yes Is Disabled No N.A. Renewal Course Year 2010 Is Admission after Diploma No Application Number APPE1245954M20042011

Residential Number: N.A, MobileNumber: 9922119446, EmailAddress: arati_thombare@ yahoo.com Address:- AT-MILKATKHAR, POST-SARAL, TAL.- ALIBAG, DIST.- RAIGARH Location:- MIL KATKHAR City:SARAL Pincode:- 402209 Taluka:- Alibag District:- Raigarh Scrutiny Committee No Parent Age 56 Issued in 2010 District Issuing Raigarh Office Taluka Issuing Office Caste Certificate Alibag No Income Certificate No Caste Validity Certificate No SETU/OBC/SR/111 2 District Issuing Office Raigarh 6924/2011 University Registration No Document Details Is Studying in night school No Hostel/ Landlord Address N.A Hostel/Landlord Contact Details N.A Hostel Admission Date Name of Landlord / N.A Hostel N.A N.A Is Mess Service Available? Hostel Type No Rent Per Month Hostel Information Parmanent Address AT-MILKATKHAR, POST-SARAL, TAL.- ALIBAG, DIST.RAIGARH Parent's name DATTATREY middle name BALKRISHNA last name THOMBARE Relation with Applicant Father Profession Parents Annual Income

55000.00 Farmer first name (yrs) Parent / Guardian Details Address For Correspondence Contact Details Student Bank Account Details BANK OF INDIA Branch Name PANVEL Bank Name Bank Account No 124410410000021

Document Attached Applicant's Signature Applicant Parent's Signature The information furnished by me is complete and correct. I bear the complete res ponsibility for all the above information. Principal's Signature Declaration Caste Certificate Issued by Competant Officer Income Proof - Income Certificate Issued by Competant Authority Marksheets I-card Size Photo Non-Crimiliar Certificate