Application Form

Student Passed SSC Exam from Open Category

Application Number Appilcation type
Student SSC Details

APPOPH0439516M20042011 Renewal Renewal Course Year 2010

Please Paste Pasport Size Photograph

SSC Board Passing Year

Applicant's Details

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION 2004 SSC Seat No OPH043951 SSC Marks Obtained 65.00

Applicant Name Date of Birth

ASHISH
first name

RAJENDRA
middle name

SHARMA
last name

Mother's Name Is Resident of Maharashtra Application Date

MEENA Maharashtra

16-08-1988

Gender

Male

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

2011-2012 Other Backward Class Sutar (174) No No Is Disabled Applicant's Annual Income Is Staying at Hostel ? Sub Caste No 0.00

12-12-2011

Disability Type

N.A. 383718.00

Total Annual Income Has Applied For Hostel ?

No

No

No

Student Prequalifying Details

Last attended School/College/Institute Last Exam Passed Passed

Institution Details

Audyogik Shikshan Mandal's Institute of Business Management & Research, Chinchwad, Pune Last Exam Passed Year 2011 Last Exam Marks 62

M.C.A 1st year Yes

Name of School/College/Institute where Admitted Course Name Subject College Admission Number Is Fees Paid ? Fee Receipt Date GrantType 102232

Audyogik Shikshan Mandals Institute of Business Management & Research, Chinchwad, Pune

Master of Computer Applications Academic Year Date Of Admission Fee Paid Course Year Is Admission after Diploma 27-07-2011 Joining Date 2011-2012 27-07-2011

Yes 27-07-2011 Non Granted

53803.00 2 No

Fee Receipt No. Quota

771

Government Quota

Contact Details

Residential Number: N.A, MobileNumber: 9028622110, EmailAddress: a.r.sharma111@gmail.com

Address For Correspondence

Address:- Namuna Lane no. 6 Nanakshahi Wada. District:- Amravati

Location:- Amravati

City:- Amravati

Pincode:- 444601

Parent / Guardian Details

Parent's name

RAJENDRA
first name

Bhagwatiprasad
middle name

SHARMA
last name

Relation with Applicant Parmanent Address

Father

Parent Age

53

(yrs)

Profession

Service

Namuna Lane no. 6 Nanakshahi Wada. Amravati.

Parents Annual Income

383718.00

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

MRC-81/Amravati/8 89 MRC-81/Amravati/ 744 MRC-81/Amravati/ 8382 2031001482

District Issuing Office District Issuing Office Issued in

Amravati

Taluka Issuing Office Scrutiny Committee No

Amravati

Amravati

2011

Student Bank Account Details

Bank Name Branch Name IFSC Code

CENTRAL BANK OF INDIA PIMPARI CBIN0280667

Bank Account No

3087513806

MICR Code

411016018

Document Attached

Caste Certificate Issued by Competant Officer Income Proof - Form 16 Income Proof - Income Certificate Issued by Competant Authority Marksheets I-card Size Photo Caste Validity Certificate Non Creamy Layer Certificate

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