First Year Diploma Engineering Admissions 2014 Application Form

DIRECTORATE OF TECHNICAL EDUCATION

3, MA HA P A LIKA MA RG, P OST BOX NO. 1967, MUMBA I - 400 001

A P P LICA TION FORM FOR A D MISSION TO FIRST Y EA R OF P OST S.S.C. D IP LOMA COURSES IN
ENGINEERING/TECHNOLOGY FOR THE A CA D EMIC Y EA R 2014-15

APPLICATION ID : DEN14156274 VERSION NO : 1

P ersonal D etails
C a n d id a te 's Na m e NA ND A NW A R SW A P NIL VITTHA LRA O
Fa th e r's Na m e VITTHA LRA O
Mo th e r's Na m e KIRTI
Ge n d e r Male
Da te o f Birth 14/10/1997
C a n d id a tu re T yp e Maharashtra - Type A
Ho m e Dis trict Nagpur
O rig in a l C a te g o ry SBC - Koshti (3)
C a te g o ry fo r Ad m is s io n SBC - Koshti (3)
P e rs o n with Dis a b ility Not A pplicable
De fe n ce T yp e Not A pplicable
Ap p lie d fo r T FW S No
Dis trict fro m wh ich ca n d id a te h a s p a s s e d Std . VI I I Nagpur
Dis trict fro m wh ich ca n d id a te h a s P a s s e d Std . I X Nagpur
Dis trict fro m wh ich ca n d id a te h a s p a s s e d S.S.C . (Std . X) Nagpur
Qualif ication D etails
Subject Marks Obtained Marks OutOf P ercentage
Ma th e m a tics 86.00 100.00 86.00
Scie n ce 98.00 100.00 98.00
En g lis h 77.00 100.00 77.00
Be s t o f 5 Ma rk s 450.00 500.00 90.00
S.S.C . Bo a rd Maharashtra State Board of Education
S.S.C . P a s s in g Y e a r 2014 S.S.C . Se a t No J055270
S.S.C . T e ch n ica l No
H.S.C . Not A pplicable/Failed I .T .I . No
I n te rm e d ia te Gra d e (Dra win g ) No
List of D ocuments Required at the time of D ocument Verif ication at A RC
Sr. No. Document Name
1. C e rti fi c a te o f I ndi a n N a ti o na l i ty i n the N a me o f the C a ndi da te .
C a s te C e rti fi c a te c l e a rl y me nti o ni ng the C a te go ry o f the C a ndi da te a nd a l s o the re ma rk s tha t the c a s te i s
2.
re c o gni s e d a s ba c k wa rd c l a s s i n the S ta te o f M a ha ra s htra .
N o n- C re a my L a y e r C e rti fi c a te i s s ue d by S ub D i v i s i o na l o ffi c e r o r D e puty C o l l e c to r o f the D i s tri c t i n a ddi ti o n to
3.
the C a s te C e rti fi c a te , v a l i d upto 3 1 s t M a rc h 2 0 1 5 .
4. S ta te me nt o f M a rk s o r C e rti fi c a te o f P a s s i ng o f S td. 8 th, 9 th a nd 1 0 th / P ro fo rma Z .
5. S ta te me nt o f M a rk s o r C e rti fi c a te o f P a s s i ng o f S td. 1 0 th / S .S .C . / E qui v a l e nt E x a mi na ti o n.
6. L a te s t S c ho o l / C o l l e ge L e a v i ng C e rti fi c a te / P ro fo rma - N .

Declaration
I h a ve re a d a ll th e ru le s o f a d m is s io n a n d o n u n d e rs ta n d in g th e s e R u le s , I h a ve fille d th is Ap p lica tio n
Fo rm fo r a d m is s io n to firs t ye a r o f P o s t S.S.C . Dip lo m a C o u rs e s in En g in e e rin g /T e ch n o lo g y fo r th e a ca d e m ic ye a r
2 0 1 4 -1 5 . T h e in fo rm a tio n g ive n b y m e in th is a p p lica tio n is tru e to th e b e s t o f m y k n o wle d g e & b e lie f. I f a t la te r
s ta g e , it is fo u n d th a t I h a ve fu rn is h e d wro n g in fo rm a tio n a n d /o r s u b m itte d fa ls e ce rtifica te (s ), I a m a wa re th a t
m y a d m is s io n s ta n d s ca n ce lle d a n d fe e s p a id b y m e will b e fo rfe ite d . Fu rth e r I will b e s u b je ct to le g a l a n d /o r p e n a l
a ctio n a s p e r th e p ro vis io n s o f th e la w.
P la ce : Da te : 29/06/2014
P rin te d O n : 29/06/2014 9:36:49 P M
La s t Mo d ifie d O n : 29/06/2014 9:27:32 P M Sig n a tu re o f Ap p lica n t
La s t Mo d ifie d By : D EN14156274, 115.248.28.185 (NA ND A NW A R SW A P NIL VITTHA LRA O)