Rayat Shikshan Sanstha

Balwant College Vita

Khanapur Road, Vita, Tal-Khanapur, Dist-Sangli
Tel:2347
272096
Email:balwantcollege_7207@yahoo.com
   

Form ID : 7816

Course : MCom-II

Academic Year : 2021-2022 Date : 22/10/2021 11:48:41 AM

Branch : Commerce

For College / Institute Use Only

Designation Remarks /Particulars Signature and Date

Admission Clerk :
Admission Committee :
Cash Received :Rs.

Accountant Cashier :
Receipt No: Date:
Registrar / Office
Suprintendent :

1.Personal Information Section

  Last Name First Name Middle Name
Name of the student : PATIL NISHA SATISH
Father / Husband's Name : PATIL SATISH SUKHADEV
Mother's Name :
  PATIL RAJASHRI SATISH
Previous Name of the student : 
(in case of changed name)
Reason for name changed : Not Applicable Marital Status : Unmarried
Date of Birth : 22-07-1999 Gender : Female
Place of Birth : Vita Blood Group : B +ve
District of Birth : Sangli State of Birth : Maharashtra
Religion : Hindu Nationality : mharata
Eligibility Number : Aadhar Card No. :  841591751038
Father's Qualification : BA Father's Occupation : farmer
Father's Annual Income 65000.00 Father's Age 52
Mother's Qualification SSC Mother's Occupation House wife
Mother's Annual Income 0.00 Mother's Age 46
Address of Correspondence :
Address : vita Pin Code :
415311
State :
maharashtra District :
sangli Tehsil :
khanapur City/ Town :
vita
Permanent Address :

Address : vita Pin Code : 415311

State :
maharashtra District :
sangli Tehsil
khanapur City/ Town :
vita
Contact Details :
Whats App Number :

Area /StdCode : Phone No.:

9922100776
Father Mobile No.: 9922100776 Mother Mobile No.:
9922100776 SMS Mobile No.: Email ID : n.patil4275@gmail.com

Have you enrolled your name in voter's list of Election Commission ?

Yes
      Voter ID No. :
8325961
If you are a Foreign National , State the details :
Nationality :
  
Passport No. : 
  
Visa No. :  
2.Legal Reservation Information Section
Category Type :
Reserved Category :
Open Caste :
HINDU Sub-Caste :
MARATHA
Domiclle of state :
Maharashtra
If Physically Challenged / Handicapped : 
NA  
3. Social Reservation Information Section
Whichever is applicable , choose name of supporting document attached in Section 7. :
Select
4. a) Previous Year (2020-2021) Selected Subjects
ADVANCED ACCOUNTANCY PAPER-I ,  ADVANCED ACCOUNTANCY PAPER-II , MANGERIAL ECONOMICS ,  MANAGEMENT CONCEPTS AND ORGANIZATIONAL BEHAVIOUR , 

4. b) Selected / Opted Papers Section

Sr. No. Subject Code Subjects
1 AAP-05 ADVANCED ACCOUNTANCY PAPER-V
2 AAP-06 ADVANCED ACCOUNTANCY PAPER-VI
3 BUFIN-01 BUSINESS FINANCE
4 MGMACC-01 MANAGEMENT ACCOUNTING
5.Educational Details Section
Grade /Total
Name of Name of Name of Date of Passing Degree/Passing Out Qualifying
Marks Result
Examination Board/University School/College (DD/MM/YYYY) Certificate Of Examination
Obtained
Adarsh madhyamik
10th Std. State Board 08/06/2015 056549 339 500 10th Passed
vidya Mandir vita
12th Std. State Board Balwant College vita 30/05/2017 045250 375 650 12th Passed
Bachelor Chhatrapati Shivaji
Balwant College vita 15/03/2020 2678430 1125 1800 B.com Passed
Degree University Kolhapur
Chhatrapati Shivaji
M.com1 Balwant College vita 01/10/2021   682 800 M.com1 Passed
University Kolhapur
6. Guardian Information Section
Guardian's Name : 
SATISH
Occupation of Guardian :
Farmer Income :
65000.00
Relationship with Guardian:
DAUGHTER Mobile No. : 
9423809257
Names of two reference and their address :  
Name : 
SATYAJIT Designation
(if any) : 
Mob.No. :
9975684075 Relationship with the Applicant :
BROTHER
Address :
vita    
Name :
SHUBHANKAR Designation (if any) : 
Mob.No. :
8484882501 Relationship with
the Applicant :
BROTHER
Address :
vita    
7. Attached Documents and Certificates Section
Sr. No. Name of Document / Certificate Attested (Yes/ No)
1 Statement of Marks Yes
2 Statement of Marks II Yes
8. Other Information Section
Mother Tongue :
 MARITHI Employment Status :
 
Unemployed Do you wish to join NCC :
No
Would you like to apply for Hostel :
 No Hobbies & Other Interests :
 READING
Games and Sports Participation :
 
No Name of Game : Level :
Courses Participation :
Not Applicable Identification Mark  :
Cultural Activities Participation : NO Interested in Earn & Learn Scheme :No Any Other Skills : SPEKING
9 .Admission Reference
Friends,
10 .Declaration
By Student
I undertake to pay the fees, as required, I am bound to pay full fees as per rule of college / institutional . I have noted the tuition fees
and other, are not refundable under any circumstances. I have carefully read the rules and procedures, which I am required to
follow for getting for admission and shall accept decision given by the Principal in this respect, as final and binding. I hereby submit
to the disciplinary jurisdiction of the authorities of the College and shall observe and abide by the rules made by the Head of the
College and respective University from time to time.
     
By Guardian  
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 with the rules and fees, dues to my son /daughter / ward and to see that he/ she observes.
     
     
Place :
Vita Student Signature Guardian Signature
 
 AFFIDAVIT BY PARENT/GUARDIAN
Date:
22/10/2021
 
1. I, Mr./Mrs./Ms. SATISH  father/mother/guardian of 
NISHA SATISH PATIL  having been admitted to
MCom-II
  have received is copy of the UGC Regulation on Cutting the Monaco of Ragging in Higher
Educational Institutions, 2009, (hereinafter called the Regulations) carefully read and fully understood the
provisions contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penalized administrative action that is liable to be taken against my ward against my ward in case he/she is
found guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.
4. I hereby solemnly aver undertake that my ward will not indulge in any behavior or act that may be
constituted as ragging under clause 3 of the Regulations. My Ward will not participate in or abet or
propagate through any act of commission or omission that may be constituted as ragging under clause 3 of
the Regulations.
5. I hereby affirm that, if found guilty of ragging. My ward is liable for punishment according to clause 9.1
of the Regulations, without prejudice to any other criminal action that may be taken against me under any
penal law or any institution in the time being in force.
6. I hereby declare that my ward has not been expelled or debarred from admission in any institution in
the country on account of being found guilty of, abetting or being part of a conspiracy to promote, ragging,
and further affirm that in case the declaration is found to be untrue, the admission of my ward is liable to
be cancelled.
 
 
_____________________________

Declared on :22/10/2021
Signature of Parent/Guardian
Name: SATISH
Address:
vita
Verification

Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit
is false and nothing has been concealed or misstated therein
Verified at

_______________________________ on ______________________________________
Signature of Parent/Guardian (Note: There is no need to get your affidavits printed on any stamp paper or
get it signed by a Notary or an oath Commissioner)

(Note: There is no need to get your affidavits printed on any stamp paper or get it signed by a Notary
or an oath Commissioner)
 ANTI RAGGING AFFIDAVIT BY THE STUDENT

Registration No.:
7542 Date:22/10/2021
 
1. I,
NISHA SATISH PATIL  having been admitted to
MCom-II
 have received is copy of the UGC Regulation
on Cutting the Monaco of Ragging in Higher Educational Institutions, 20009, (hereinafter called the
Regulations) carefully read and fully understood the provisions contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penal and administrative action that in liable to be taken against me in case I am found guilty for abetting
ragging actively or passively, or being part of conspiracy to promote ragging.
4. I hereby solemnly aver and undertake that I will not indulge in any behavior or act that may be
constituted as ragging under clause 3 of the Regulations. I will not participate in or abet or propagate
through any act of commission or omission that may be constituted as ragging under clause 3 of the
Regulations.
5. I hereby affirm that, if found guilty of ragging. I am liable for punishment according to clause 9.1 of the
Regulations, without prejudice to any other criminal action that may be taken against me under any penal
law or any institution in the time being in force I hereby declare that I have not been expelled or debarred
from admission in any institution in the country on account of being found guilty of, abetting or being part
of a conspiracy to promote, ragging, and further affirm that in case the declaration is found to be untrue, I
am aware that my admission is liable to be cancelled.
 
 
 
_____________________________

Declared on :22/10/2021
Signature of Student
Name: NISHA SATISH PATIL
Address:
vita
 
Verification

Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit
is false and nothing has been concealed or misstated therein
Verified at

_______________________________ on ______________________________________