Application Form

Application Number Appilcation type

Student SSC Details

APPE0677894M20072012 New Renewal Course Year N.A

Please Paste Pasport Size Photograph

SSC Board Passing Year

Applicant's Details

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION 2007 SSC Seat No E067789 SSC Marks Obtained 64.00

Applicant Name Date of Birth

ROSHAN
first name

RAMESH
middle name

KILJE
last name

Mother's Name Is Resident of Maharashtra Application Date

RESHMA Maharashtra

18-09-1991

Gender

Male

Academic Year Caste Category Caste Orphan Is Applicant Salaried ? Maritial Status

2011-2012 Vimukta Jat Nomadic Tribes Gavali (36) No No Is Disabled Applicant's Annual Income Is Staying at Hostel ? Sub Caste No 0.00

31-12-2011

Disability Type

N.A. 239725.00

Total Annual Income Has Applied For Hostel ?

No

No

No

Student Prequalifying Details

Last attended School/College/Institute Last Exam Passed Passed

Institution Details

KET 'V.G.VAZE COLLEGE OF ARTS, SCIENCEAND COMMERCE Last Exam Passed Year 2011 Last Exam Marks 42

FY.B.COM Yes

Name of School/College/Institute where Admitted Course Name Subject College Admission Number Is Fees Paid ? Fee Receipt Date GrantType Granted Bachelor of Commerce COMMERCE 2007071132

Principal,V.G.Vaze College,Mulund,Mum-

Academic Year Date Of Admission Fee Paid Course Year Is Admission after Diploma 27-04-2011 Joining Date

2011-2012 07-06-2011

No

0.00 2 No

Fee Receipt No. Quota Government Quota

Contact Details

Residential Number: N.A, MobileNumber: 9766845017, EmailAddress: rohnk439@gmail.com

Address For Correspondence

Address:- ROM NO.001 PLOT NO.359 PRIYANKA APT KANSAI SECTION AMBERNATHEAST AMBERNATH City:- 421501 Pincode:- 421501 District:- Thane

Location:-

Parent / Guardian Details

Parent's name

RAMESH
first name

RAMA
middle name

KILJE
last name

Relation with Applicant Parmanent Address

Father

Parent Age

54

(yrs)

Profession

Service

ROM NO.001, PLOT NO.359, PRIYANKA APT, KANSAI SECTION, AMBERNATH (EAST

Parents Annual Income

239725.00

Hostel Information

Name of Landlord / Hostel Hostel Type

N.A

Hostel Admission Date Is Mess Service Available? No Rent Per Month

N.A

N.A

N.A

Hostel/ Landlord Address

N.A

Hostel/Landlord Contact Details

N.A

Is Studying in night school

Document Details

No

Caste Certificate No Caste Validity Certificate No Income Certificate No University Registration No

SETU/MSC/NT/114 405

District Issuing Office District Issuing Office

Ratnagiri

Taluka Issuing Office Scrutiny Committee No

Chiplun

Thane

K.PRESHA/TE1/ SR2051

Issued in

2011

Student Bank Account Details

Bank Name Branch Name IFSC Code

Bank Account No

MICR Code

Document Attached

Caste Certificate Issued by Competant Officer Income Proof - Income Certificate Issued by Competant Authority Marksheets I-card Size Photo Non Creamy Layer Certificate SSC Mark Sheet

Declaration

The information furnished by me is complete and correct. I bear the complete responsibility for all the above information.

Applicant's Signature

Applicant Parent's Signature

Principal's Signature