Application Form

Printed on Course 8/13/2013 12:12:14 PM Bachelor of Commerce GOI Post Matric Scholarship , 2013-2014 Vimukta Jat Nomadic Tribes

Application Number Appilcation type Student SSC Details SSC Board Passing Year

APPE1773604M20112013 New Renewal Course Year N.A

Please Paste Passport Size Photograph

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION 2011 SSC Seat No E177360 SSC Marks Obtained 74.00

Applicant's Details Applicant Name SANTOSH Date of Birth 28-02-1996 NATHURAM Gender Maritial Status KATE Male No Mother's Name ANITA

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

Application Date 25-07-2013 Caste Orphan Gavali (36) No

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 70000.00 No

Has Applied For Hostel ?

Student Prequalifying Details

Academic Year Institute Course Course Year Percentage Result

2012 - 13 2011 - 12 2010 - 11

K.D.NAGADA .JR.COLLEGE OF COMMMERCE K.D NAGADA.JR.COLLEGE OF COMMERCE ABHINAV DNYAN MANDIR USAR KHURD

12 th Commerce 11 th Commerce SSC

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66.33 62.33 74.00

Pass Pass Pass

Institution Details Name of School/College/Institute where Admitted Course Name Course Year EID Number Subject College Adm.No 402 Is Fees Paid ? Fee Receipt Date Contact Details No N.A Academic Year Admission Dt. Fee Paid GrantType 2013-2014 20-06-2013 0.00 Granted Is Admission after No Diploma Joining Date 20-06-2013 Fee Receipt No. Quota Government Quota Principal,M.L.Dahanukar College Of Comm.,Vile-parle(E),Mum-57(Aided)

Bachelor of Commerce 1 CAP Number N.A UID Number 771540908912

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

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Address For Correspondence Address:- Location:- GEN.A.K.VAIDYA MARG City:- GOREGAON EAST Pincode:- 400063 Taluka:- Mumbai (Suburban) District:- Mumbai (Suburban) Parent / Guardian Details Parent's name N.A N.A N.A Age Profession N.A(yrs) N.A

Relation with Applicant N.A Parmanent Address Is Father Alive Hostel Information Name of Landlord / Hostel Hostel Type Hostel/ Landlord Address Is Studying in night school Document Details Caste Certificate No Caste Validity Certificate No Income Certificate No 188/2011 N.A District Issuing Raigarh Office District Issuing Raigarh Office 2013 No Is Mess Service Available? No N.A Yes

Annual Income N.A

Hostel Admission Date Rent Per Month Hostel/Landlord Contact Details 0.00

Taluka Issuing Office Scrutiny Committee No University Registration No

Tala N.A N.A

C/MHMSBO/20273 Issued in /2013 Student Bank Account Details Bank Name Branch Name IFSC Code UNION BANK OF INDIA VILE PARLE (EAST) - MUMBAI UBIN0531979

Bank Account No MICR Code

319702010751608

400026037

Document Attached Caste Certificate Issued by Competant Officer Income Proof Income Certificate Issued by Competant Authority Marksheets I-card Size Photo 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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