Merit List No.

Payment : Online / DD / Cash Amount Verified by (Sign)

Merit List Sr.No.
For Office use only:
Vidyavardhini's Remarks
Annasaheb Vartak College of Arts, Kedarnath Malhotra College of Commerce &
E.S. Andrades College of Science, Vasai Road (W)
Dist. - Palghar - 401 202 (NAAC ACCREDITED B++ GRADE)
Office Phone No. 0250-2332017 / +91 7721885222:
College Email ID: t23avcollegevasai@gmail.com

JUNIOR COLLEGE
College College Admission Application Form Academic Year : 2021-22
Code:1808001
Course Applied for : FYJC : Commerce
Application Date : 23/08/2021 Payment Category: JRCOL0000005619
1. PERSONAL INFORMATION:
Candidate's Name շեռ֊֑֞ֈ֗
(Marathi)

Candidate's Full Name YADAV KANCHAN SHATRUGHAN

as printed on SSC
Statement of Marks:*

Candidate's Father's SHATRUGHAN YADAV Marital Status : UnMarried

/ Husband's Name
Mother's Name : SUNITA YADAV Mother Tongue HINDI

Place of Birth : SAHORBA Gender : Female Date of Birth 11/12/2005

Blood Group : Religion : Hindu Citizenship INDIAN
Height : Weight : Hemoglobin :
Is Students - Domicile State MAHARASHTRA Aadhar No. : 231259567730
NRI/Foreign National :
Address for Correspondence :
State : MAHARASHTRA District : PALGHAR Tehsil : VASAI City/Town/Vil. NALLASOPARA
Address (House No, Street / C/403,Shyam Kutir Society Near Little Flower Pin Code : 401203
Area/Suburb etc:) School Samel Pada,Nallasopara West Nale
Permanent Address :
State : MAHARASHTRA District : PALGHAR Tehsil : VASAI City/Town/Vil. NALLASOPARA
Address (House No, Street / C/403,Shyam Kutir Society Near Little Flower Pin Code : 401203
Area/Suburb etc:) School Samel Pada,Nallasopara West Nale
Contact details :
Student's Own Mobile Number Whatsapp Mobile Number Parent Mob Number Student's Email ID
9967775779 9967775779 9967878519 ky65668@gmail.com
2. LEGAL RESERVATION INFORMATION
Category Type OPEN Category General
Caste - Sub Caste
3. OTHER PARALLEL RESERVATIONS:
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\rdlc\admission\subAdmissionReservation.rdlc. Please check the log files for more information.
4. COURSES (SUBJECTS) SELECTED FOR:
ENGLISH, BOOK-KEEPING AND ACCOUNTANCY, ECONOMICS, ORGANIZATION OF COMMERCE,
MATHEMATICS, ENVIRONMENTAL SCIENCE, HEALTH AND PHYSICAL EDUCATION, HINDI / I.T.
Medium of Instruction : English
5. GUARDIAN INFORMATION:
Occupation of Guardian : Service Annual Income of Guardian : Below 1 Lakh
6. EDUCATIONAL DETAILS
Examinations Name of Name of School / UDISE No Month & Year Exam Marks Out of %
Passed Board College of Passing Seat No. Obt. Total
Marks

Std. 10th MAHARASHT SACRED HEART 27361716102 03/2021 A165926 415 500 83.00
RA STATE HIGH SCHOOL
BOARD OF
SECONDARY
AND HIGHER
SECONDARY
EDUCATION,
PUNE
7. LAST QUALIFYING EXAMINATION SSC BOARD
8. LIST OF DOCUMENTS REQUIRED FOR ADMISSION:
S.S.C. School Leaving Certificate
S.S.C. Statement of Marks
Residence Proof (Any One) Copy of Voter ID/Driving
Aadhar Card

DECLARATION
I hereby declare that all the information furnished by me in this application form is true, complete and correct to the best of
my knowledge and belief. I do understand that I need to obtain and produce all the required documents. I application No. :
JRCOL0000005619 (Student's name : YADAV KANCHAN SHATRUGHAN) further declare that I am fully aware that my
admission to this Institute will be treated as confirm only after physical verification of all documents required for admission,
fulfilling ELIGIBILITY CRITERIA and obtaining clearance from SCRUTINY PROCESS. I have read and understood the
instructions, rules and regulations given in this form and shall undertake all steps to abide by all the rules and regulations
laid down by the institute, fulfill all the criteria of attendance and satisfactory completion of the work. I also declare that there
is no criminal case against me. If any information submitted herein is found fraudulent, incorrect or untrue, I am liable for
criminal prosecution.
Candidate Place : NALLASOPARA Date : 23/08/2021 Signature :

Guardian Place : NALLASOPARA Date : 23/08/2021 Signature :

For College office use only:

Designation : Remarks/Particulars/Recommendations Signature and Date
Admission Clerk : Name
Admission Committee Member Name
Accountant/Cashier Cash/DD Recd. Receipt No. Date
Registrar/O.S. Name