APPLICATION FORM

Reference No

Form No

101691
First Name

Level Name

Course Name

Category

POST GRADUATE

MCOM (B&F)

OPEN

: VARSHA DEVI

Middle Name : JAYPRAKASH

Surname

Address

ROOM NO. 375, SHAHID BHAGAT SINGH NAGAR,

KUMBHARWADA, SION

Pin Code

400019

: SINGH

Mother Name : MANJU DEVI

Nationality

: INDIAN

Phone(with STD):

Mobile: 7715905958

Date of Birth : 10/9/1993

Email ID

singhvarsha143341@gmail.com

Gender: FEMALE

Native Place

Native Address :

UP

Father's Name: JAYPRAKASH SINGH

Mother's Name :

MANJU DEVI

Occupation

Occupation

: UP

: BUSINESS

Office Address:

Office Address :

Phone No.

Phone No.

Email ID

Email ID

Moblie No.

: 9967532778

Moblie No.

Annual Income: 144000

Annual Income :

GuardianName:

Phone No.

Relation

Email ID

Occupation

Moblie No.

Office Address:
12th PCM

: Phy -

Entrance Exam:

Chem -

Merit Score

Maths -

Education

Board

Year of Passing

% Marks or CGPA

Class

Specialization

SSC

MAHARASHTRA

2010

61.20%

NA

HSC

MAHARASHTRA

2012

54.50%

COMMERCE

GRADUATION

MUMBAI

2015

62.16%

BAF

Declaration ( to be signed by applicant and Parent / Local Guardian )

1) I shall abide by all the rules and regulations of the Mumbai University and Govt. of Maharashtra and the Institute.
2) I shall be regular in attending all lectures, tutorials, tests, practicals, workshop and examinations conducted.
3) I was not debarred from appearing for any examination conducted either by any Government Constituted or any other Statutory
Examination Authority in India.
4) I shall pay fees and other charges by the due date. If the fee structure is revised, the difference in fees will paid accordingly. In event of
default, the Principal of the Institute may take any action as he might deem fit.
5) I shall pay fees for complete duration of the course before collecting Leaving/ Trasnfer Certificate.
6) All the information provided in the form is true.
Place : Mumbai

Date : 25-Aug-2015

____________________
Signature of the Applicant

_____________________
Signature of Parent/Guardian