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Form No.
14217

Dombivli Shikshan Prasarak Mandal's Education

K V Pendharkar College
of Arts, Science and
Commerce
ADMISSION FORM

XII COMMERCE (UNAIDED) (2021-2022)

The Principal,
K V Pendharkar College of Arts, Science and Commerce
Opposite MIDC Office, Dombivli (E), Mumbai

I wish to apply for admission to the

XII Commerce (Unaided)
 Class. I give below the necessary particulars.

Student Name
AHIRE
PARTH
RUPESH

Mother's Name
SARIKA

Sex
Male
Aadhar Card No.
618817394335

Marital Status
Unmarried
Blood Group
A+

Date of Birth
08/Nov/2004
Place of Birth
LASANGAU

Place of Birth's Taluka

Kalyan
Place of Birth's Dist
Thane

Place of Birth's State

Nashik
Place of Birth's Country
India

Nationality
Indian
Mother Tongue
Marathi

Religion
BUDDHISM
Category
SC

Caste
BUDDHIST

Enrolled for Voter's List?

No

Correspondence Address ROOM NO 1 CHAWL NO 1 MORYA COLONY VASUNDRI ROAD OPP PANCHVATI

BLDG TITWALA WEST - 421605 - 421605

Native Place Address ROOM NO 1 CHAWL NO 1 MORYA COLONY VASUNDRI ROAD OPP PANCHVATI

BLDG TITWALA WEST

Native District
THANE
Native State
Maharashtra

Telephone No. (Resi)

9326016291

Student Whatsapp No.

9594403809
Guardian Mobile No.
9082921112

Student Email ID
parthahire077@gmail.com
Guardian Email ID
Sarikaahire@gmail.com

Railway Concession Upto

Titwala

Physically Challenged
N/A

Subjects Offered
ENGLISH

ORGANIZATION OF COMMERCE

BOOK KEEPING & ACCOUNTANCY

ECONOMICS

HEALTH AND PHYSICAL EDUCATION

ENVIRONMENTAL EDUCATION

SECRETARIAL PRACTICE

MARATHI
P.T.O.
 Form No.
14217
Name of the Board / Mon. & Year Total Out of / Attempt
Examination Name of the College Seat No
University of Passing Marks Grade / SGPA

S16.17.197-K.N.T.PUBLIC SCH.,
SSC Maharashtra State Board MAR 2021 A065954 311 500 1
PLOT.NO.36, TITWALA-(E), KALYAN-

MAHARASHTRA STATE
XI MAY 2022 K.V. PENDHARKAR COLLEGE 210863 307 600 --
BOARD

Parents / Guardian Details

Name
RUPESH AHIRE
Relationship
FATHER
Office Address
TITWALA, THANE 421605
Occupation
PRIVATE EMPLOYEE
Annual Income (Rs.)
200000

DECLARATION BY STUDENT
1. I declare that I will not confirm my admission to any other college before cancelling the admission from this college.
2. I will submit all my original documents to college. I am aware that if information in my admission form is found incorrect / If I
submitted my original documents in another college my admission will be treated as cancelled.
3. I declare that all the information I have given in this application is true, correct and complete, and is not false or misleading. I
understand giving false or
misleading information is a serious offence.
4. I declare that the signature on this form is my signature and has not been signed on my behalf by another person.
5. I agree to tell D.S.P.M’s K .V .Pendharkar College of Arts, Science and Commerce (Autonomous) immediately if there is any
change in the information I have given in this application.
6. I understand the College reserves the right to vary or reverse any decision made on the basis of incorrect, incomplete, false or
misleading information which I may have provided, including in some circumstances, termination of my enrollment.
7. I declare that I have not been excluded or subject to disciplinary action at any institution.
8. I understand that the College may obtain official records from any educational institution I have previously attended or my
employer.
9. I know that Second Language Selection at SYJC has to be same as per the subject selection in FYJC (for Junior College).
10. I know that the Information Technology Subject will be given purely on selection of Subject (IT) & merit at College level (for
Junior College).
11. I know that to opt Mathematics subject for Commerce, marks in the SSC examination should be more than 70% (for Junior
College).
12. I am aware that payment of the admission form fees not refundable at the time of registration does not confirm the admission.
The college authorities deserve all the rights to reject the application if it is incomplete or doesn’t satisfy the norms of the
institution.
13. I am aware that any incorrect information given in the application may result in a rejection of my application at the institution’s
discretion.
14. I am aware that I must provide the College with the supporting documentation of my application via online application platform.
Failure to do so may result in a rejection of application.
15. I am aware that hard copies should be submitted at college as and when notified by the administration of the College. Any
documents submitted if found altered, forged or tampered with, the college reserves the right to cancel the application without
notice to the applicant.
16. I am aware that admission given on the basis of the scanned documents uploaded by the candidate will be provisional and will be
confirmed only after the physical submission and verification of documents with the original ones by competent authorities.
17. I am aware that if I’m eligible for freeship/scholarship and apply for it in the application form but miss the deadlines for applying
the same to the concerned agencies as suggested by the respective authorities from time to time, I will not be considered for the
relevant fee concessions.
Date: 10-May-2022

(Signature of the Student)

DECLARATION BY PARENT / GUARDIAN

I ,hereby fully endorse the above undertaking/declaration given by my child/ward. And I will endeavor to induce my child/ward to do
his/her best to observe the above stated undertaking in words and
spirit.
Date: 10-May-2022

(Signature of the Parent / Guardian)

UPLOADED DOCUMENT INFORMATION

Following Documents are uploaded:

XI MARKSHEET

NOTE: ATTACH THE PHOTOCOPY OF THE FOLLOWING DOCUMENTS AND CERTIFICATES

1. For F.Y.J.C. (XI) Admission - Marksheet of SSC.
2. For S.Y.J.C. (XII) Admission - Marksheet of SSC & F.Y.J.C. (XI)
3. Caste Certificate (if any).
4. Address Proof (Any one - Aadhar Card / Passport / Electricity Bill / Telephone Bill)