For Office Use
Batch: Scrutiny Payment: Online/DD PI
Only Serial:
Birla College of Arts, Science and Commerce (23)
Application No :
University of Mumbai 27206
[Link], Fort, Mumbai-400032, Maharashtra(India)
Academic Year: 2024-2025 Regular
APPLICATION FORM
Course Applied for : [Link]. ([Link] I.)(Autonomous)(with Credits) - PRN:2021016401804016
Regular - CBCS - T.Y. [Link]. (B. and I.)(Autonomous) Sem V (-)
Application Date : 17/07/2024 Payment Category : 13
[Link] Information
Candidate's Name(Regional) :
Candidate's Name as printed JADHAV SUMIT SANTOSH JAYSHREE
on Mark sheet : [*This name will appear on all University records/documents]
Mother's
Father's/Husband's Name : SANTOSH JAYSHREE
Name :
Mother
Marital Status : UnMarried
Tongue :
Place Of Birth : Ambernath Gender : Male Date of Birth (DD/MM/YYYY) : 24/05/2003
Blood Group : Religion : Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Thane Tehsil : Thane City/Town/Village :
Available
Address (House
RAMKRISHNA HARI RAHIVASI SEVA SANGH CHAWL NO 2 GAIKWAD PADA 1
no,street/area/suburb Pin Code : 421005
ULHASNAGAR
etc.) :
Contact details
Mobile
7738629636 Email ID: sumitj2703@[Link]
Number
[Link] Reservation Information
Category Type :
Category : SC
Reserved
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? No
[Link] Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem V
BBI001 - PAPER I BBI002 - PAPER II
BBI003 - PAPER III BBI004 - PAPER IV
Sem VI
BBI005 - PAPER V BBI006 - PAPER VI
BBI007 - PAPER VII BBI008 - PAPER VIII
Medium of Instruction : English
[Link] Information
Occupation of Guardian : Laborer Annual Income of Guardian : 54000
[Link] Details
Month Exam
Name of Name of Board/University Name of Certificate Mark Out
and Year Seat CGPA %
Examination and State of University School/College No. Obtained of
of Passing No.
MAHARASHTRA STATE
BOARD OF SECONDARY
Std 10th June 2019 -- -- 245.00 500.00 -- - -- 49.00
AND HIGHER SECONDARY
EDUCATION,
MAHARASHTRA STATE
Std 12th 12Th BOARD OF SECONDARY August
-- -- 454.00 600.00 -- - -- 75.67
(Commerce) AND HIGHER SECONDARY 2021
EDUCATION,
Your Last Qualifying Exam:
[Link] Information
Would you like to apply for Hostel accommodation required NA
DECLARATION
I hereby declare that all the information furnished by me in this application form is true, complete and correct to the best of my
knowledge and belief. I do understand that I need to obtain and produce all the required documents. I admit to having
understood what constitutes ragging and sexual harassment. I have read the guidelines related to the same. I hereby affirm that if
found guilty of ragging or sexual harassment I am liable for punishment according to the university regulations.
Place : Date :
( Signature of the Candidate )
Document printed on Wed Jul 17 2024 [Link] GMT+0530 (India Standard Time)
