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Application No: Regular

This document is an application form for a Bachelor of Commerce program. It contains personal information about the applicant such as name, date of birth, address, guardian and family details. It also includes the applicant's educational history and marks/grades from Standard 10th and 12th. The form notes the applicant's category for reservation purposes and confirms they do not have any disabilities. It lists the papers selected for the first and second semesters of the program. At the end, the applicant declares the information is true and understands the policies on ragging and sexual harassment. Spaces are also included for recommendations and signatures from the admitting college.

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prashant mhatre
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62 views

Application No: Regular

This document is an application form for a Bachelor of Commerce program. It contains personal information about the applicant such as name, date of birth, address, guardian and family details. It also includes the applicant's educational history and marks/grades from Standard 10th and 12th. The form notes the applicant's category for reservation purposes and confirms they do not have any disabilities. It lists the papers selected for the first and second semesters of the program. At the end, the applicant declares the information is true and understands the policies on ragging and sexual harassment. Spaces are also included for recommendations and signatures from the admitting college.

Uploaded by

prashant mhatre
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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For Office Use

Batch: Scrutiny Payment: Online/DD PI

Only Serial:

Birla College of Arts, Science and Commerce (23)

Birla College Road.


Kalyan
Application No :

University of Mumbai 2564225

M.G.Road, Fort, Mumbai-400032, Maharashtra(India)

Academic Year: 2022-2023


Regular
APPLICATION FORM

Course Applied for : B.Com. (B.and I.)(Autonomous)(with Credits) - Regular - CBCS - F.Y. B.Com. (B. and I.) PRN:
(Autonomous) Sem I 
(-)

Application Date : 08/09/2022 Payment Category :


1.Personal Information

Candidate's Name(Regional) : खैरे अथर्व अनिल


Candidate's Name as printed on Mark KHAIRE ATHARVA ANIL
sheet : [*This name will appear on all University records/documents]

Father's/Husband's Name : ANIL Mother's Name : MEERA

Marital Status : UnMarried Mother Tongue : Marathi


Place Of Birth : SOLAPUR Gender : Male Date of Birth (DD/MM/YYYY) : 25/09/2003
Blood Group : Religion : Hindu Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
City/Town/Village :
State : Maharashtra District : Thane Tehsil : Kalyan Location Area : Urban
KALYAN
Address (House DATTATRAY COLONY ACHANAK SOCIETY CHAWL NO 6 ROOM NO 10 BIRLA
Pin Code : 421301
no,street/area/suburb etc.) : COLLEGE KALYAN WEST
Permanent Address :
City/Town/Village :
State : Maharashtra District : Thane Tehsil : Kalyan Location Area : Urban
KALYAN
DATTATRAY COLONY ACHANAK SOCIETY CHAWL NO 6 ROOM NO 10 BIRLA
Address : Pin Code : 421301
COLLEGE KALYAN WEST
Contact details
Mobile Number 7738556631 Email ID: [email protected]
2.Legal Reservation Information
Category Type :
Category : SC Sub Category : BURUD
Reserved
Is Guardian from EBC (Economic Backward
Is Specially Abled? No
Class)?  No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem I
BBI1001 - Paper 1 BBI1002 - Paper 2
BBI1003 - Paper 3 BBI1004 - Paper 4
Sem II

BBI2001 - Paper 1 BBI2002 - Paper 2


BBI2003 - Paper 3 BBI2004 - Paper 4

Medium of Instruction : English


4.Guardian Information
Occupation of Guardian : Laborer Annual Income of Guardian : 50000
5.Educational Details
Month
Name of Name of Board/University and State of Name of Exam Certificate Mark
and Year Out of CGPA %
Examination University School/College Seat No. No. Obtained
of Passing
Month
Name of Name of Board/University and State of Name of Exam Certificate Mark
and Year Out of CGPA %
Examination University School/College Seat No. No. Obtained
of Passing
MAHARASHTRA STATE BOARD OF
NUTAN March
Std 10th SECONDARY AND HIGHER A061473 -- 329.00 500.00 --
-
-- 65.80
VIDYALAY 2019
SECONDARY EDUCATION,Maharashtra
MAHARASHTRA STATE BOARD OF B.K.BIRLA
Std 12th March
SECONDARY AND HIGHER COLLEGE M147875 -- 454.00 600.00 --
-
-- 75.67
Commerce 2021
SECONDARY EDUCATION,Maharashtra KALYAN WEST
Your Last Qualifying Exam: HSC/Std 12th [Commerce]
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Passing Certificate of Std 12th / Statement of Marks of Std 12th OR Original Passing Certificate /Statement of Marks of Last Qualifying Exam like
degree,diploma,etc.

Certificate of Caste with Category.

Leaving Certificate.

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
Application No :2564225 (KHAIRE ATHARVA ANIL)
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 )
For College/Institute/Study Center Use Only
Designation Remarks / Particulars / Recommendations Signature and Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: INR Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Thu Sep 08 2022 18:15:12 GMT+0530 (India Standard Time)

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