EXAMINATION FORM

Roll No. 19203A0067 *19203A0067* COMPUTER ENGINEERING

To,
The Principal,Vidyalankar Polytechnic , Wadala (E) , Mumbai - 400037

Sir/Madam, I request permission to present myself for the semester 1 (I - SCHEME) examination to be held in Nov - 2019. I hereby declare that I have not joined any other College/s for prosecuting studies for
this examination, or have not appeared at the said exam of any other University, or have not joined any other University, for this or any other course. Yours faithfully,
CHAMUR ADVAY CHETAN 7738798690

Sign of student Surname First Middle Mobile

Sr. No. Scheme Code Subject Name PR TW

1 22001 FUNDAMENTALS OF ICT 9 9

2 22003 ENGINEERING GRAPHICS 9 9

3 22005 WORKSHOP PRACTICE 9 9

4 22101 ENGLISH 9 9

5 22102C BASIC CHEMISTRY 9 9

6 22102P BASIC PHYSICS 9 9

FOR OFFICE USE Admission Fee Summary (To be verified at the accounts department)
Course Year Quota Category Div Total Payable Payable Paid Govt. Arrears College Arrears Total Arrears Receipt No. SW Eligible SW Status

FIRST YEAR INST OPEN A ୓ ୓ ୓ ୓ ୓ ୓ 551586 - -

9: Head of passing appearing 8 : Head of passing Not Applicable EL: Eligible NE: Not Eligible C: SW Activity Completed I: SW Activity Incomplete

ON SCRUTINY OF THE DOCUMENTS AND VERIFICATION OF HIS/HER ATTENDENCE DURING THE TERM, I CERTIFY THAT THE STUDENT IS ELIGIBLE FOR APPEARING FOR EXAMINATION AS ABOVE AND HIS
APPLICATION ALONG WITH REQUISITE EXAMINATION FEES, WITH LATE FEES AS APPLICABLE, MAY BE ACCEPTED.

__________________________________ ___________________________________ __________________________________ __________________________________

Head CO Dept. Exam fee Receipt No. Head Account Dept. Principal

Printed On : 11-09-2019 15:45:20 PM