For Office Use

Batch: Scrutiny Payment: Online/DD PI

Serial:
Only

Birla College of Arts, Science and Commerce (23)

Birla College Road.

Kalyan
Application No :

University of Mumbai
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)

86176

Academic Year: 2022-2023 Regular

APPLICATION FORM

Course Applied for : B.Com. (A.and F.)(Autonomous)(with Credits) - Regular - CBCS - F.Y. B.Com. (A. PRN:
and F.)(Autonomous) Sem I 
(-)

Application Date : 11/06/2022 Payment Category :

1.Personal Information
Candidate's Name(Regional) : जाधव दिक्षा संतोष
JADHAV DIKSHA SANTOSH
Candidate's Name as printed on
[*This name will appear on all University

Mark sheet :
records/documents]

Father's/Husband's Name : SANTOSH Mother's Name : LAXMI

Marital Status : UnMarried Mother Tongue : Marathi
Place Of Birth : KALYAN Gender : Female Date of Birth (DD/MM/YYYY) : 11/04/2004
Blood Group : Religion : Hindu Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
City/Town/Village :
State : Maharashtra District : Thane Tehsil : Kalyan Location Area : Urban
KALYAN
Address (House
no,street/area/suburb CHAWL NO A/20 ROOM NO 08 SAHYADRI NAGAR KALYAN Pin Code : 421301
etc.) :
Permanent Address :
City/Town/Village :
State : Maharashtra District : Thane Tehsil : Kalyan Location Area : Urban
KALYAN
Address : CHAWL NO A/20 ROOM NO 08 SAHYADRI NAGAR KALYAN Pin Code : 421301
Contact details
Mobile
7738655152 Email ID: dikshujadhav906@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : GEN
Open
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)?  No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem I
AF1001 - Paper 1 AF1002 - Paper 2
AF1003 - Paper 3 AF1004 - Paper 4
Sem II

AF2001 - Paper 1 AF2002 - Paper 2

AF2003 - Paper 3 AF2004 - Paper 4

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Service Annual Income of Guardian : 0
5.Educational Details
Month
Name of Name of Board/University and Name of and Year Exam Certificate Mark Out
CGPA %
Examination State of University School/College of Seat No. No. Obtained of
Passing
MAHARASHTRA STATE BOARD
OF SECONDARY AND HIGHER POTE March
Std 10th A066675 -- 387.00 500.00 --
-
-- 77.40
SECONDARY VIDYALAY 2020
EDUCATION,Maharashtra
MAHARASHTRA STATE BOARD
Std 12th OF SECONDARY AND HIGHER BK BIRLA June
M322721 -- 430.00 600.00 --
-
-- 71.67
MCVC SECONDARY COLLEGE 2022
EDUCATION,Maharashtra
Your Last Qualifying Exam: HSC/Std 12th [MCVC]
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Passing Certificate of Std 12th / Statement of Marks of Std 12th OR Original Passing Certificate /Statement of Marks of Last
Qualifying Exam like degree,diploma,etc.

Passing Certificate of Std 10th.

Leaving Certificate.

Domicile Certificate.

Passing Certificate of Std. 10th.

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 :86176
(JADHAV DIKSHA SANTOSH)
admit to having understood what constitutes ragging and sexual harassment. I have
read the
guidelines related to the same. I hereby affirm that if found guilty of
ragging or sexual harassment I am liable for punishment
according to the university
regulations.

Place : Date  :
( Signature of the Candidate )
For College/Institute/Study Center Use Only
Designation Signature and
Remarks / Particulars / Recommendations
Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: INR Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Sat Jun 11 2022 16:06:35 GMT+0530 (India Standard Time)