Session : 2021-22

Shri Swami Vivekanand Shikshan Sanstha`s College Code

VIVEKANAND COLLEGE, KOLHAPUR :VC
(AUTONOMOUS)
2130, E Ward, Tarabai Park, Kolhapur, Maharashtra 416003
For College Course Applied to: B.A. B.A. SEM 5 General Reg No.
use only 1681500
Admission Date :

01. Applicant's Personal Deails

Name of the Student LAST NAME FIRST NAME MIDDLE NAME

KUPWADE TEJAS DEEPAK

Mother's Name VAISHALI

Student Name (Hindi)

Date of Birth 09-03-2001 Place of Birth : MIRAJ

Permanent Address PLOT. NO.9, SAVKAR LANE, INDAI NAGAR, MOREWADI , KOLHAPUR

Hostel Accomodation False

Marital Status Unmarried Blood Group B +Ve

Religion Hindu Gender Male

Nationality Indian AdharCardNo 562301551936

Mother Tongue MARATHI Medium MARATHI

Is Sports Person Employment Status No

NSS/NCC True Caste HINDU LINGAYAT

Caste Category Open Sub Caste ”Ȳ…˜

Enrollment Number 9850859197 Prn Number Black Mole on right hand,

Physical Handicapped No Organ Donar No

Saral No U-DISE No 2019014689

Bank Details 04400100027722 Bank of baroda Tarabai park kolhapur BARB0TARABA

Social Reservation

2) Father's / Husband's Name DEEPAK

Occupation Service Gross Annual Income 900000

Mobile No 9850859197

Relationship Father

3) Address for Correspondence

Address PLOT. NO.9, SAVKAR LANE, INDAI NAGAR,
MOREWADI , KOLHAPUR

State MAHARASHTRA District KOLAHPUR

Tehsil KARAVEER City/Town/Village Kolhapur

Pincode 416013

4) Contact Details
Student Phone 9834668743 Parent Phone 9850859197

Mobile No 9834668743

Student Email Id tdkupwade2001@gmail.com

Payment Mode
5) Previous Exam Details :
Exam Name Total Mark Out Of Mark Percentage Previous Passing Year
School Name
Sem-IV 0 0 0
Sem-III 0 0 0

6) Documents Submitted :
Passing Certificate of Std. 10th
7) Subject Name
Sr.No Subject Name
History
English

Declaration by Student
I hereby declare that, I have read the rules related to the admission and the information filled in by me in this form is accurate and
true to the best of my knowledge.I will be responsible for any discrepancy,arising out of the form signed by me and I undertake that,in absence of
any document the final admission will not be granted and/or admission will stand cancel.

Date: Signature of the Student

Declaration by Guardian / Parent

I have permitted my son / daughter ward to join your college.The information supplied by him / her is correct to the best of my
knowledge. I have acquainted myself with the rules and fees, dues to my son / daughter / ward and to see that he / she observes.

Date: Signature of the Guardian/Parent

For College / Institute Use Only

Designation Remarks / Particulars / Recomendations Signature and Date

Admission Clerk

Admission Committee

Accountant / Cashier

Registrar / Office Superintendent

REMARK OF THE ADMISSION COMMITEE

May be admitted to class ___________________________________________________________ Section ________________________

May be Rejected _________________________________________________________________________________________________

Last date of payment of fees _______________________________________________________________________________________

Admission may be canceled if the fees are not paid by this date.

Principal Signature of Admission Commitee