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  • Dr. Babasaheb Ambedkar Technological University, Lonere Registration Form

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    Rutika Zambre
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    Rutika Zambre has submitted a registration form for Dr. Babasaheb Ambedkar Technological University. She provides her personal details including name, date of birth, address, contact information, and educational qualifications. She is applying under the Other Backward Class category and has submitted required documents including her caste, validity, and non-creamy layer certificates. Her educational details include passing SSC and Diploma exams from the Maharashtra State Board with over 77% and 93% respectively. She declares that the information provided is true and correct.

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    Registration Form

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    Rutika Zambre has submitted a registration form for Dr. Babasaheb Ambedkar Technological University. She provides her personal details including name, date of birth, address, contact information, and educational qualifications. She is applying under the Other Backward Class category and has submitted required documents including her caste, validity, and non-creamy layer certificates. Her educational details include passing SSC and Diploma exams from the Maharashtra State Board with over 77% and 93% respectively. She declares that the information provided is true and correct.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    8 views2 pages

    Dr. Babasaheb Ambedkar Technological University, Lonere Registration Form

    Uploaded by

    Rutika Zambre
    Rutika Zambre has submitted a registration form for Dr. Babasaheb Ambedkar Technological University. She provides her personal details including name, date of birth, address, contact information, and educational qualifications. She is applying under the Other Backward Class category and has submitted required documents including her caste, validity, and non-creamy layer certificates. Her educational details include passing SSC and Diploma exams from the Maharashtra State Board with over 77% and 93% respectively. She declares that the information provided is true and correct.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Dr.

    Babasaheb Ambedkar Technological University, Lonere


    Registration Form
    Application Date ( अजा ची तारीख़ ): 06-01-2022 Registration No :BATU2123248

    Personal Information (वैयितक मिहती )

    Father’s/ Husband’s
    Last Name(आडनाव): First Name(पिहले नाव): Name(विडलांचे नाव/ पतीचे
    नाव):

    Candidate's Name (िवाया चे


    ZAMBRE RUTIKA MADHUKAR
    नाव) :

    ZAMBRE RUTIKA
    Mother’s Name (आईचे नाव) : KANCHAN Full Name (पूण नाव):
    MADHUKAR

    Marital Status (वै वािहक िथती): Unmarried Mother Tongue(मातृ भाषा): Marathi

    Place of Birth(जमथान):
    Gender(िलंग): Female Date of Birth(जम तारीख): 07-06-2001
    NAGPUR

    Blood Group(रत गट): Religion(धम ): Hindu Country of Citizenship(नागिरकव): India

    Address for Correspondance (संपकसाठी पा )

    City/Town/ Village(शहर /
    District(िजहा): Tahsil(तहसील):
    State(राय): Maharashtra गाव / खे डे ):
    Chandrapur Chandrapur
    CHANDRAPUR

    Address (House
    Pin Code(िपन कोड):
    no,street/area/suburb etc.) घर BHIWAPUR WARD OM NAGAR NEAR SAMAY MEDICAL
    442403
    मांक, रता / े  / उपनगर इ.

    Permanent Address (थायी पा )

    City/Town/ Village(शहर /
    District(िजहा): Tahsil(तहसील):
    State(राय): Maharashtra गाव / खे डे ):
    Chandrapur Chandrapur
    CHANDRAPUR

    Address (House
    Pin Code(िपन कोड):
    no,street/area/suburb etc.) घर BHIWAPUR WARD OM NAGAR NEAR SAMAY MEDICAL
    442403
    मांक, रता / े  / उपनगर इ.

    Contact details(संपका ची मािहती)

    Mobile Number(भ मणविन मांक ): 9527094184 E-mail ID (ई - मेल आयडी): rutikazambre@gmail.com

    Reservation Information(आरण मािहती)

    Category Type(जातीचे कार ): Other Backward Class Category(जातीचे वग ): Kunabi

    Are You Applying For In House Quota? : No

    Is Specially Abled?(िदयांग) : NA

    Social Information (Additional Info)सामािजक मािहती (अितिरत मािहती)

    Not Applicable

    Required Documents and Certificates Section (आवयक कागदपे आिण माणपे िवभाग) :

    1. Caste Certificate Doc

    2. Caste Validity Certificate Doc

    3. Non Creamy Layer Certificate Doc

    Educational Details(शै िणक तपशील)

    Registration Obtained
    No. Level University Name Pass Year Seat No. Total Marks Percentage
    No. Marks
    MAHARASHTRA
    STATE BOARD OF
    SECONDARY AND
    1 SSC 10th / S.S.C. 2018 J062394 386.00 500.00 77.20
    HIGHER
    SECONDARY
    EDUCATION

    Page 1 of 2 Print Date:06-01-2022 09:55:51 PM


    Registration Obtained
    No. Level University Name Pass Year Seat No. Total Marks Percentage
    No. Marks
    MAHARASHTRA
    STATE BOARD OF
    2 Diploma TECHNICAL Diploma 2021 251168 1636.00 1750.00 93.49
    EDUCATION
    (MSBTE)

    Admission Prefrences List (वेश ाधाय यादी):

    Course Branch College Amount Status

    Declaration by the Student I hereby declare that, I have read the rules related to admission as given in the prospectus/ website and that the information/
    Documents furnished by me are true and complete to the best of my knowledge. If the information/ Documents are found to be incorrect at any point, my
    Admission will stand cancelled & I am liable to be prosecuted & Institute will not be responsible for the same.

    Place(जागा): Date(तारीख) :
    ( Signature of the Candidate):

    Page 2 of 2 Print Date:06-01-2022 09:55:51 PM

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