‘Application Form No : BKBC/ B. K. BIRLA COLLEGE OF ARTS,SCIENCE & COMMERCE (Autonomous), KALYAN Conducted By Kalyan Citizen's Education Society (Aitated To University of Mumba) Re-Accredited (3rd Cycle) By NAAC with’A’ Grade (CGPA- 3.58) Application for Admission to () ‘Applicants Personal Details : Name of the Student ‘Student Name(MARATHI) First name Fathers name Mother Gender ‘adhaar card No. Marital status: Blood Group: Date of Birth: Place Of Birth: Place of Birth City: Place of Birth State: Place of Birth Tehsil: Place of Birth Country: Nationality Voter i category caste: Mother Tongue: Differently Abled: Stream: Uni. Pre-Reg.No. : Employment Status : ‘Address of Correspondence : ‘Address State: iste: Pinco City/TownvVillage: Residential Area: Permanent/Native Address : ‘Address State: District: Pincode: City/TownvVillage: Residential Area: Contact Details: ‘Student's Mobile No: Students Email: Parent's/Guardian's Mobile No: Parent's/Guardiaris Emall ld Parent’ Details: Name: Occupation Annual Ineome(Rs.) Office Address1. Education Details Section [Examination] Name of Board] Year of Passing|Name Of inetitute|[Seat Number] Obtained Marks] Max Marks|Perentage| Grade] 2, Last Qualifying Subject Details: ‘Subject Name Obtained Marks Max Marks 3. Subjects Offered Sr.No. Group Name Subject Name Declaration by Student | hereby declare that, i have read the rules related to admission and the information filled by me in this form is accurate and true to the best of my knowledge. | will be responsible for any discrepency, arising out ofthe form signed by me and | undertake that, in absense of any document the final admission will not be granted and/or admission will stand cancel ORDINANCES 0.119 RELATING TO THE ATTENDANCE Following shall be the minimum atttendance necessary for keeping terms. FIRST TERM/SEMESTER ThreeFourths of days on whch lectures are delievered. SECOND TERM/SEMESTER Three- Fourths of days on which lectures are delievered, ‘ORDINANCE 0.125 - MUMBAI UNIVERSITY To keep a term an undergraduate must complete to the satisfaction ofthe principal of course of study at the college prescribed for such term for the class to which such graduate then belongs. Students who fail to satisfy the condition laid down in aageand 0.125 will not be permitted to appear atthe College and University. Students are advised to note that under the power aiven tothe Principal under satisfactory performance at the preliminary examination is made a pre-condition for being to appear for Examination Non appears or unsatisfactory performance at Examination will not be excused on Any Ground, Examination: Absence on Medical or Non Medical grounds should be supported by medical certificate in case of ines or by Satisfactory evidence i it's on non-medical grounds, The medical must be informed about leave of absence within one week of Such absence. A student whose Attendance is consistently unsatisfactory is liable for disciplinary action. Further he/she will not cannot be ‘waived or relaxed in case of employed students. IMPORTANT Raging ls stritly prohibited in the college premises and outside, Student including in agging other student will be punished as per the Maharashtra Prohibition of Ragging Act,1999(Mah XXXiIl of 1999) published in Maharashtra Govt, Gazzette on 15th May 1999, Such student will also be expelled from the college and FLR, will be lodged with the police against them, The student found guilty of ragging earlier will not be admitted inthis college.UNDERTAKING BY THE STUDENT. 1.$.0/0.0. of Mr/Mrs./Ms. FATH have carefully read and fully understood the aw prohibiting ragging and the direction of the supreme court and the Central/State Government in this regard. 2.1have Read a copy of the UGC regulation Curbing the Menace of Ragging n Higher Education Institutes,2009 and i have carefully ‘gone through it. 3.1hereby agree that if found guilty of any aspect of ragging. | May be punished as per the provisions of the UGC/University of Mumbai Regulation mentioned above and/or as per the law in force. 4.\hereby affirm that i have not been expelled or debarred from admission by any institution, S. hereby undertake that | will register my name in the voters list withthe State Election Commission, Government of Maharashtra as soon as | complete the age of 18th Years Date Place ‘Signature of Student UNDERTAKING BY THE PARENT/GUARDIAN | FATH FO/M.0/6.0. have carefully read and fully understood the law prohibiting ragging and the direction of the Supreme Court, {and the Central/State Government inthis regard as well as UGC Regulation on Curbing the menace of Raging in Higher Educational Institutes,2009. 2.Lassure you that my son/daughter /ward will not indulge in any act of ragging, 3. hereby agree that iT he/she is found gultyof any aspect of ragging, he/she may be punished as per the provision of the UGC. Regulation Mentioned above and/or as per the law in force. Date Place: Signature of Parent/Guardian UNIVERSITY OF MUMBAI DECLARATION / AN UNDERTAKING FROM THE STUDENT ‘hereby declare that have read al the rules and regulations framed by the college authorities as given in college prospectus, which are presenti in force. 2. hereby declare and undertake to abide by all the mentioned rules and regulations and hereby agree, if admitted.to confirm to them and to such other rules as may hereafter be made for the smooth functioning ofthe college. 3.1 may not be granted terms or allowed to appear for the College/University Examination if my attendance in lectures and tutorials/practcals falls short of 75% 411 may not be granted any concession in any matter, if take up any employment during the course of my studies. S.1hereby declare that | shall show satisfactory progress and maintain good conduct. 6.1hereby declare that ihave not registered my name at any other institution for any other full time course. 7.1hereby declare that the information filed in by me inthis form is accurate and true tothe best of my knowledge .| Will be responsible for any discrepancyarising out of the form signed by me and | undertake tha, in absence of any document the final ‘admission willnot be granted and/or admission will stand cancelled | WILL DISPLAY MY IDENTITY CARD PROMINENTLY IN THE COLLEGE PREMISES. 9.1have given my and my parents most recent contact details(Phone, Email). In case of any change | undertake to inform college accordingly. 10.1 hereby give my consent for use of my contact details for educational communication 111. am aware that as per University Circular No.SW/42 of 2015 dtd. 29th Oct. 2015, lam compulsorily required to give and Undertaking on wawantiragging.in & www amanmovement.org 12.1 will get myself enrolled for Voter ID card when | would tun 18 Years of age, 18.1 am aware that If eligible for Scholarship/Freeship scheme of Social Welfare Department then | must complete al the formalities In time. If fall to do so then i undertake to pay fll fees of course by end of October of the Current Academic year. 14, Ihave read eligibility conditions of University of Mumbai for my course. My admission wil be confirmed subject to confirmation from University of MumbaiDate Place Signature of Student DECLARATION BY PARENT/GUARDIAN 1 (Mother/Father/Guardian) hereby fully endorse the above undertaking/declaration given by my child/ward. And | will endevor to induce my child/ward to do his/her vest to observe the above stated undertaking in words and spirit Date Place ‘Signature of Parent/Guardian 4, Attached Documents StNo. Name of Documents/Certificate Note: ‘Attach the photocopy ofthe following documents and certificates: 1.x Marksheet. 2.xIl Marksheet, 3.For S.Y. Admission: Marksheet of FY. Sem & Sem I 4.For TY, Admission Marksheet of FY, Sem | & Sem Il and Marksheet of SY, Sem ll & Sem IV, 5.Caste Certificate & Caste Validity Certificate ary). 6.Address Proof(Asdhar Card Passport/ Electricity Bill Telephone Bill)