Application Form

Printed on Course 7/7/2013 11:13:40 AM Bachelor of Architecture GOI Post Matric Scholarship , 2013-2014 Vimukta Jat Nomadic Tribes

Application Number Appilcation type Student SSC Details SSC Board Passing Year

APPK0024143M20112013 New Renewal Course Year N.A

Please Paste Passport Size Photograph

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION 2011 SSC Seat No K002414 SSC Marks Obtained 84.36

Applicant's Details Applicant Name NISHA Date of Birth 15-10-1994 GANESH Gender Maritial Status MARGE Female No Mother's Name SANDHYA

Is Resident of Maharashtra Maharashtra Caste Category Sub Caste Vimukta Jat Nomadic Tribes

Application Date 07-07-2013 Caste Orphan Bhoi (25) 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 35000.00 No

Has Applied For Hostel ?

Student Prequalifying Details

Academic Year Institute Course Course Year Percentage Result

2012 - 13 2011 - 12 2010 - 11

SHIVCHHATRAPTI COLLEGE, 12 th (Science) AURANGABAD SHIVCHHATRAPTI COLLEGE, 11 th Science AURANGABAD ST.LAWRENCE HIGH SCHOOL, AURANGABAD SSC

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63.83 61.00 84.36

Pass Pass Pass

Institution Details Name of School/College/Institute where Admitted Course Name Course Year EID Number Subject College Adm.No 13105 Is Fees Paid ? Fee Receipt Date Contact Details No N.A Academic Year Admission Dt. Fee Paid GrantType 2013-2014 06-07-2013 0.00 Non Granted Is Admission after No Diploma Joining Date 06-07-2013 Fee Receipt No. Quota Government Quota M.G.M.'s Jawaharlal Nehru Engineering College, Aurangabad-431003

Bachelor of Architecture 1 CAP Number N.A UID Number 616555123131

Residential Number: N.A, MobileNumber: N.A, EmailAddress: N.A

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Address For Correspondence Address:- Location:- KESHWANAND NAGAR City:- AURANGABAD Pincode:- 431006 Taluka:- Aurangabad District:- Aurangabad 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 GANESH KESHAVRAO MARGE Age Profession (yrs) Labour

Location:- KESHWANAND NAGAR City:- AURANGABAD Pincode:- 431006 Taluka:Aurangabad District:- Aurangabad Annual Income 35000.00 Yes

N.A

Hostel/ Landlord N.A Address Is Studying in night school Document Details Caste Certificate No Caste Validity Certificate No 2013/CASTE/NT/C District Issuing Aurangabad R-849 Office A184379 District Issuing Aurangabad Office Issued in 2013

Taluka Issuing Office Scrutiny Committee No University Registration No

Aurangabad EDUA/LOT NO235/SR.17 N.A

Income Certificate 3037 No Student Bank Account Details Bank Name Branch Name IFSC Code STATE BANK OF INDIA

Bank Account No MICR Code

31935785666

GARKHEDA, AURANGABAD SBIN0011514 431002015

Document Attached Caste Certificate Issued by Competant Officer Income Proof Income Certificate Issued by Competant Authority Marksheets I-card Size Photo Caste Validity Certificate Non Creamy Layer Certificate SSC Mark Sheet UID 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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