9/20/2021

For Office Use

Batch: Scrutiny Payment: Online/DD PI

Only Serial:

Khandesh College Education Society`s S. S. Maniyar Law College (100005)

Application No :
Kavayitri Bahinabai Chaudhari North Maharashtra University, Jalgaon 52362
Grade 'A' NAAC Re-accredited (3rd Cycle) Jalgaon-425001, Maharashtra,(India)
Academic Year: 2021-2022 Regular
APPLICATION FORM

Course Applied for : LL.B(with Credits) - Regular - under CBCS [June-2019] Pattern - LL.B Part-II Sem-III (-) PRN:2020015400327236
Application Date : 20/09/2021 Payment Category : 1
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed on School ROZATKAR SUJATA DILIP
leaving/Passing Certificate : [*This name will appear on all University records/documents]
Father's/Husband's Name : DILIP ROZATKAR Mother's Name : KALPANA
Marital Status : UnMarried Mother Tongue :
Place Of Birth : JAMNER Gender : Female Date of Birth (DD/MM/YYYY) : 12/01/1998
Blood Group : Religion : Country of Citizenship : India
Height : Not Available Weight : Not Available Hemoglobin : Not Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Jalgaon Tehsil : Jamner City/Town/Village :
Available
Address (House
PLOT NO 41 PURUSHOTTAM NAGAR JAMNER Pin Code : 424206
no,street/area/suburb etc.) :
Contact details
Mobile Number 917875382638 Email ID: [email protected]
2.Legal Reservation Information
Category Type :
Category : SC
Reserved

Is Specially Abled? No
3.Social Information(Additional Inforamtion)

Paper Selected for:

Sem-III
8471 - L-201 Labour Law-I 8472 - L-202 Jurisprudence
8473 - L-203 Transfer of Property 8476 - L-205 Alternative Dispute Resolution (Clinic Paper-II)
8475 - L-211 Law Relating To Women and Child

Sem-IV

8481 - L-206 Labour Law-II 8482 - L-207 Public International Law

8483 - L-208 Administrative Law And Right to Information 8484 - L-209 Law of Evidence
8485 - L-210 Company Law

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Service Annual Income of Guardian : 976389
5.Educational Details
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9/20/2021
5.Educational Details
Month and Exam
Name of Name of Board/University and State of Name of Certificate Mark Out
Year of Seat CGPA %
Examination University School/College No. Obtained Of
Passing No.
MAHARASHTRA STATE BOARD OF
Std 10th SECONDARY AND HIGHER SECONDARY June 2013 -- -- 493.00 550.00 -- - -- 89.64
EDUCATION,
Std 12th MAHARASHTRA STATE BOARD OF
12Th SECONDARY AND HIGHER SECONDARY May 2015 -- -- 440.00 650.00 -- - -- 67.69
(Science) 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 )

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9/20/2021
[COLLEGE COPY]

For Office Use

Batch: Scrutiny Payment: Online/DD PI

Serial:
Only

Khandesh College Education Society`s S. S. Maniyar Law College (100005)

Application No :
Kavayitri Bahinabai Chaudhari North Maharashtra University, Jalgaon
Grade 'A' NAAC Re-accredited (3rd Cycle) Jalgaon-425001, Maharashtra,(India)
52362
Academic Year: 2021-2022 Regular
APPLICATION FORM

Course Applied for : LL.B(with Credits) - Regular - under CBCS [June-2019] Pattern - LL.B Part-II Sem-III (-) PRN:2020015400327236
Application Date : 20/09/2021 Payment Category : 1
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed on School ROZATKAR SUJATA DILIP
leaving/Passing Certificate : [*This name will appear on all University records/documents]
Father's/Husband's Name : DILIP ROZATKAR Mother's Name : KALPANA
Marital Status : UnMarried Mother Tongue :
Place Of Birth : JAMNER Gender : Female Date of Birth (DD/MM/YYYY) : 12/01/1998
Blood Group : Religion : Country of Citizenship : India
Height : Not Available Weight : Not Available Hemoglobin : Not Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Jalgaon Tehsil : Jamner City/Town/Village :
Available
Address (House
PLOT NO 41 PURUSHOTTAM NAGAR JAMNER Pin Code : 424206
no,street/area/suburb etc.) :
Contact details
Mobile Number 917875382638 Email ID: [email protected]
2.Legal Reservation Information
Category Type :
Category : SC
Reserved
Is Specially Abled? No
3.Social Information(Additional Inforamtion)

Paper Selected for:

Sem-III
8471 - L-201 Labour Law-I 8472 - L-202 Jurisprudence
8473 - L-203 Transfer of Property 8476 - L-205 Alternative Dispute Resolution (Clinic Paper-II)
8475 - L-211 Law Relating To Women and Child

Sem-IV

8481 - L-206 Labour Law-II 8482 - L-207 Public International Law

8483 - L-208 Administrative Law And Right to Information 8484 - L-209 Law of Evidence
8485 - L-210 Company Law

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Service Annual Income of Guardian : 976389

3/4
9/20/2021
5.Educational Details
Month and Exam
Name of Name of Board/University and State of Name of Certificate Mark Out
Year of Seat CGPA %
Examination University School/College No. Obtained Of
Passing No.
MAHARASHTRA STATE BOARD OF
Std 10th SECONDARY AND HIGHER SECONDARY June 2013 -- -- 493.00 550.00 -- - -- 89.64
EDUCATION,
Std 12th MAHARASHTRA STATE BOARD OF
12Th SECONDARY AND HIGHER SECONDARY May 2015 -- -- 440.00 650.00 -- - -- 67.69
(Science) 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 Mon Sep 20 2021 22:11:03 GMT+0530 (India Standard Time)

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