SATISH PRADHAN DNYANASADHANA COLLEGE,

THANE
UA
(ARTS, SCIENCE & COMMERCE)
M.Com. - II APPLICATION FORM - (2017-2018)

DATA VARIFICATION
Attach and tick the applicable documents

Photocopy / Xerox of Lastest Marksheets

Photocopy / Xerox of Caste Certificate (If applicable)

Professor / Teacher Signature

Original prospectus bought from the College & Date

ACADEMIC RECORD
Examination Board / College Total Marks Obtained / SGPA

M.Com. - I Dnyanasadhana College, Thane 0.00

COURSE PREFERENCES
Subjects Preference: N/A

Addon Courses Opted: ///////////

CANDIDATE'S PROGRAM & PERSONAL INFORMATION

GI No. / Prospectus
3646 / 1722717 / 7738932556
Number / Mobile No.

Academic Year / 2017-2018 / M.Com. - II /

Program / PRN No. 2011016401963484

Candidate's Full Name Dubey Snehlata Jayprakash Sandhya

Paste passport size
Gender / Birth Date / photograph
Birth Place / Blood Group Female / 31-Aug-1993 / Thane / N/D / Thane
/ Native Place

Email Address & Mobile

sweetydubey3108@gmail.com / 8652309546
No.

Candidate's Aadhar No.

267678508096 / Indian
(UIDAI) / Nationality

Religion / Mother Tounge Hindu / Hindi

Quota General /

Category / Caste / Sub-

Caste / Caste Certificate General / Open / brahmin / 1234
No. Students Sign:
Previous School with
R.J THAKUR VEER SAWARKAR NAGAR THANE
Address:

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FAMILY - ADDRESS AND CONTACT INFORMATION

Father's Full Name Dubey Jaiprakash Ramkripal

Mother's Maiden Name Sandhya

Mother or Father Aadhar

914085092967
No. (UIDAI)

Parents Mobile Numbers

8652309546 /
& Land Line Numbers

Parents Mobile Numbers

& Email

ROOM NO.3KALPANATH DUBEY CHAWLSHIVAJI WADINR HANUMAN

Correspondence Address
MANDIRWAGLE ESTATETHANE WEST

Taluka / District / State

Thane / Thane / Maharashtra / India / 400604
and Country / Pin Code

ROOM NO.3KALPANATH DUBEY CHAWLSHIVAJI WADINR HANUMAN

Native Address
MANDIRWAGLE ESTATETHANE WEST

Land Line / Mobile

8652309546
Numbers

UNDERTAKING: The information provided in this application form is

correct. In case of any issues arise in future I will remain
responsible for it. Students Signature

Form Filled: 103.220.32.21 2017-07-05 10:42:15 PM