Application Form

Printed on Course 7/22/2013 11:11:01 AM Bachelor of Architecture GOI Post Matric Scholarship , 2013-2014 Other Backward Class

Application Number Appilcation type Student SSC Details SSC Board Passing Year

APPH0864686M20062013 Renewal Renewal Course Year 2012

Please Paste Passport Size Photograph

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION 2006 SSC Seat No H086468 SSC Marks Obtained 52.26

Applicant's Details Applicant Name BHUSHAN Date of Birth 21-05-1990 ARUN Gender Maritial Status PANDAV Male No Mother's Name TULSABAI

Is Resident of Maharashtra Maharashtra Caste Category Sub Caste Other Backward Class

Application Date 09-07-2013 Caste Orphan Teli (181) Yes

Is Disabled Applicant's Annual Income

No 0.00

Disability Type

N.A.

Is Applicant Salaried ? NO Is Staying at Hostel ? No

Total Annual Income 55000.00 No

Has Applied For Hostel ?

Student Prequalifying Details

Academic Year Institute Course Course Year Percentage Result

2012 - 13 2010 - 11

sinhgad college of architecture Bachelor of Architecture sinhgad college of architecture DIPLOMA IN INTERIOR DESIGINING AND DECORATION (ID)

1 2

68.00 59.26

Pass Pass

Institution Details Name of School/College/Institute where Admitted Course Name Course Year EID Number Subject Sinhgad College of Architecture, Vadgaon, Pune

Bachelor of Architecture 2 CAP Number N.A UID Number 654092712863

1207/80092/04434 22/01/2013 17:14:59 Academic Year Admission Dt. Fee Paid GrantType 2013-2014 08-07-2013 0.00 Non Granted Is Admission after Diploma Joining Date No

SUSTAINABLE ARCH. College Adm.No 1952 Is Fees Paid ? Fee Receipt Date Contact Details No N.A

08-07-2013

Fee Receipt No. Quota Government Quota

Residential Number: , MobileNumber: 9767758849, EmailAddress: pandavbhushan@gmail.com Address For Correspondence Address:- Location:- OM NAGAR City:- NANDURA Pincode:- 443404 Taluka:- Nandura District:- Buldana 1 Of 2

Parent / Guardian Details Parent's name Relation with Applicant Parmanent Address Is Father Alive Hostel Information Name of Landlord / Hostel Hostel Type N.A Is Mess Service Available? No Hostel Admission Date Rent Per Month Hostel/Landlord Contact Details No 0.00 N.A ARUN HARIBHAU PANDAV Age Profession 45(yrs) Business

Location:- OM NAGAR City:- NANDURA Pincode:- 443404 Taluka:- Nandura District:Buldana Annual Income 55000.00 Yes

N.A

Hostel/ Landlord N.A Address Is Studying in night school Document Details Caste Certificate No Caste Validity Certificate No MRC-81/8093/2005 District Issuing Buldana -06 Office 163753 District Issuing Akola Office Issued in 2012

Taluka Issuing Office Scrutiny Committee No University Registration No

Nandura 2 N.A

Income Certificate 4639 No Student Bank Account Details Bank Name Branch Name IFSC Code

CENTRAL BANK OF INDIA SINHAGAD TECHNICAL EDUCATION SOCIETY CBIN0284444

Bank Account No MICR Code

2967062431

411016030

Document Attached Caste Certificate Issued by Competant Officer Marksheets I-card Size Photo Caste Validity Certificate Non Creamy Layer Certificate SSC Mark Sheet UID document xerox EID document xerox Declaration The information furnished by me is complete and correct. I bear the complete responsibility for all the above information. Applicant's Signature Principal's Signature _______________________ _______________________ Applicant Parent's Signature _______________________

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