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Birla College of Arts, Science and Commerce (23)

Birla College Road. Kalyan Application No :
University of Mumbai 1396688
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
Academic Year: 2023-2024 Regular
APPLICATION FORM

Course Applied for : B.Com. (Autonomous)(with Credits) - Regular -

PRN:
CBCS - F.Y. B.Com.(Autonomous) Sem I (BCOMAUTO1001)

Application Date : 12/06/2023 Payment Category :

1.Personal Information
Candidate's Name(Regional) : पद्यल जागृति चंद्रकांत
Candidate's Name as printed PADYAL JAGRUTI CHANDRAKANT
on Mark sheet : [*This name will appear on all University records/documents]
Mother's
Father's/Husband's Name : CHANDRAKANT MAYA
Name :
Mother
Marital Status : UnMarried Marathi
Tongue :
Place Of Birth : BETAWADH Gender : Female Date of Birth (DD/MM/YYYY) : 01/08/2004
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
ROOM NO.3, CHAWL NO. 16/A, SHAYADRI NAGAR NO.2 , BIRLA COLLEGE
no,street/area/suburb Pin Code : 421301
ROAD KALYAN WEST, THANE
etc.) :
Permanent Address :
City/Town/Village :
State : Maharashtra District : Thane Tehsil : Kalyan Location Area : Urban
KALYAN
ROOM NO.3, CHAWL NO. 16/A, SHAYADRI NAGAR NO.2 , BIRLA COLLEGE
Address : Pin Code : 421301
ROAD KALYAN WEST, THANE
Contact details
Mobile
9137767424 Email ID: [email protected]
Number
2.Legal Reservation Information
Category Type :
Category : OBC Sub Category : SUTAR
Reserved
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem I
BCOM1001 - Paper 1 BCOM1002 - Paper 2
BCOM1003 - Paper 3 BCOM1004 - Paper 4
Sem II

BCOM2001 - Paper 1 BCOM2002 - Paper 2

BCOM2003 - Paper 3 BCOM2004 - Paper 4

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Laborer Annual Income of Guardian : 130000
5.Educational Details
 Month
Name of Name of Board/University Name of and Exam Certificate Mark Out
CGPA %
Examination and State of University School/College Year of Seat No. No. Obtained of
Passing
MAHARASHTRA STATE
NUTAN
BOARD OF SECONDARY AND May
Std 10th VIDHALAYA A062031 096389 391.00 500.00 -- - -- 78.20
HIGHER SECONDARY 2021
KALYAN WEST
EDUCATION,Maharashtra
MAHARASHTRA STATE B K BIRLA
Std 12th BOARD OF SECONDARY AND COLLEE OF ARTS May
M184473 -- 306.00 600.00 -- - -- 51.00
Commerce HIGHER SECONDARY COMMERCE AND 2023
EDUCATION,Maharashtra SCIENCE
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.

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 :1396688
(PADYAL JAGRUTI CHANDRAKANT) 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 Signature and
Remarks / Particulars / Recommendations
Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: INR Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Mon Jun 12 2023 14:12:30 GMT+0530 (India Standard Time)