For Office Use
Batch: Scrutiny Payment: Online/DD PI
Only Serial:
C. K. Thakur Arts, Commerce and Science College (491)
Application No :
University of Mumbai
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
242888
Academic Year: 2024-2025 Regular
APPLICATION FORM
Course Applied for : B.Sc. (I.T.) (Autonomous)(with Credits) - Regular PRN:2023016401098236
- CBCS - S.Y.B.Sc. (I.T.) (Autonomous) Sem III (-)
Application Date : 31/07/2024 Payment Category : 25
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed ANSARI SADAF NASIR
on Mark sheet : [*This name will appear on all University records/documents]
Mother's
Father's/Husband's Name : NASIR SHAMA
Name :
Mother
Marital Status : UnMarried
Tongue :
Place Of Birth : Vashi Gender : Female Date of Birth (DD/MM/YYYY) : 16/11/2004
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 : Raigad Tehsil : Panvel City/Town/Village :
Available
Address (House
no,street/area/suburb Room No.205 Patel Mohalla Bharat Nagar Old Panvel ,410206 Pin Code : 410206
etc.) :
Contact details
Mobile
917208772146 Email ID:
[email protected]Number
2.Legal Reservation Information
Category Type :
Category : GEN
Open
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem III
BSCITA301 - Paper 1 BSCITA302 - Paper 2
BSCITA303 - Paper 3 BSCITA304 - Paper 4
Sem IV
BSCITA401 - Paper 1 BSCITA402 - Paper 2
BSCITA403 - Paper 3 BSCITA404 - Paper 4
Medium of Instruction : English
4.Guardian Information
Occupation of Guardian : Laborer Annual Income of Guardian : 55
5.Educational 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 March
Std 10th -- -- 304.00 500.00 -- - -- 60.80
AND HIGHER SECONDARY 2021
EDUCATION,
MAHARASHTRA STATE
Std 12th 12Th BOARD OF SECONDARY
May 2023 -- -- 331.00 600.00 -- - -- 55.17
(Science) AND HIGHER SECONDARY
EDUCATION,
Your Last Qualifying Exam:
7.Other 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 31 2024 16:22:39 GMT+0530 (India Standard Time)
