For Office Use

Batch: Scrutiny Payment: Online/DD PI

Serial:
Only

KAMLA NEHARU MAHAVIDYALAYA (116)

SAKKARDARA SQUARE
Application No :

RASHTRASANT TUKADOJI MAHARAJ NAGPUR UNIVERSITY

Chhatrapati Shivaji Maharaj Administrative Premises, Ravindranath Tagore Marg, Nagpur,MH.(India)

18128

Academic Year: 2021-2022 Regular

APPLICATION FORM

Course Applied for : B.SC. - Regular - Regular - F.Y.B.SC First Semester 

(-) PRN:
Application Date : 07/12/2021 Payment Category :
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) : खुशी सुनिल वाकोडीकर
KHUSHI SUNIL WAKODIKAR

Candidate's Name as printed on

[*This name will appear on all University

School leaving/Passing Certificate :

records/documents]
SHEELA SUNIL
Father's/Husband's Name : SUNIL WAKODIKAR Mother's Name :
WAKODIKAR
Mother Tongue
Marital Status वैवाहिक स्थिती : UnMarried Marathi
मातृभाषा :
Place Of Birth जन्मस्थान : Nagpur Gender लिंग : Female Date of Birth जन्मतारीख (DD/MM/YYYY) : 10/11/2002
Blood Group रक्त गट : BPositive Religion धर्म : Hindu Country of Citizenship नागरिकत्वाचा देश : India
Weight : Not
Height : Not Available Hemoglobin : Not Available
Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :

State राज्य : Maharashtra District : Nagpur City/Town/Village :

Tehsil : Nagpur City Location Area : Urban
NAGPUR
Address (House
TANDAPETH LAL DARWAJA EKNATH WADI NAGPUR Pili Mata Chowk
no,street/area/suburb Pin Code : 440017
Nagpur
etc.) :
Permanent Address :
City/Town/Village :
State राज्य : Maharashtra District : Nagpur Tehsil : Nagpur City Location Area : Urban
NAGPUR
TANDAPETH LAL DARWAJA EKNATH WADI NAGPUR Pili Mata Chowk
Address : Pin Code : 440017
Nagpur
Contact details
Mobile Email ID ई - मेल आयडी:
7249837670
Number wakodikarkhushi@gmail.com
2.Legal Reservation Information
Category Type : Category जातीचा प्रकार
Sub Category पोटजातीचा प्रकार : KOSHTI
Reserved : SBC
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)?  Yes
3.Social Information(Additional Inforamtion)
University staff/family member
Paper Selected for:
First Semester
1T6 - Supplemetry English 1T24 - Biochemistry -I
1T25 - Biochemistry-II 1T26 - Biochemistry PRACTICAL
 1T27 - Biotechnology-I 1T28 - Biotechnology-II
1T29 - Biotechnology PRACTICAL 1T66 - Chemistry-I
1T67 - Chemistry-II 1T68 - Chemistry PRACTICAL
1T1 - Compulsory English

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian पालकाचा व्यवसाय : Service Annual Income of Guardian पालकाचे वार्षिक उत्पन्न : 80000
5.Educational Details
Month Out
Name of Name of Board/University and Name of and Year Exam Certificate Mark Of
Examination State of University School/College of Seat No. No. Obtained एकू ण CGPA %
Passing गुण
MAHARASHTRA STATE BOARD
OF SECONDARY AND HIGHER
Std 10th -- -- 415.00 500.00 --
-
-- 83.00
SECONDARY
EDUCATION,Maharashtra
Std 12th
N039668 53327 373.00 650.00 --
-
-- 57.38
Science
Your Last Qualifying Exam: HSC/Std 12th [Science]
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Leaving Certificate.

Statement of Marks of Std 10th

Self affidavit regarding gap in academic year (Gap Certificate)

Caste Validity Certificate

Certificate of Caste with Category.

Passing Certificate of Std 12th / Statement of Marks of Std 12th.

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 :18128
(KHUSHI SUNIL WAKODIKAR)
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.

Please submit necessary documentary evidence at the time of submission of this application form at the concerned
Faculty/College

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
[COLLEGE COPY]

For Office Use

Batch: Scrutiny Payment: Online/DD PI

Only Serial:

KAMLA NEHARU MAHAVIDYALAYA (116)

SAKKARDARA SQUARE
Application No :

RASHTRASANT TUKADOJI MAHARAJ NAGPUR UNIVERSITY 18128

Chhatrapati Shivaji Maharaj Administrative Premises, Ravindranath Tagore Marg, Nagpur,MH.(India)

Academic Year: 2021-2022 Regular

APPLICATION FORM

Course Applied for : B.SC. - Regular - Regular - F.Y.B.SC First Semester 

(-) PRN:
Application Date : 07/12/2021 Payment Category :
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) : खुशी सुनिल वाकोडीकर
KHUSHI SUNIL WAKODIKAR

Candidate's Name as printed on

[*This name will appear on all University

School leaving/Passing Certificate :

records/documents]
SHEELA SUNIL
Father's/Husband's Name : SUNIL WAKODIKAR Mother's Name :
WAKODIKAR
Mother Tongue
Marital Status वैवाहिक स्थिती : UnMarried Marathi
मातृभाषा :
Place Of Birth जन्मस्थान : Nagpur Gender लिंग : Female Date of Birth जन्मतारीख (DD/MM/YYYY) : 10/11/2002
Blood Group रक्त गट : BPositive Religion धर्म : Hindu Country of Citizenship नागरिकत्वाचा देश : India
Weight : Not
Height : Not Available Hemoglobin : Not Available
Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :

State राज्य : Maharashtra District : Nagpur City/Town/Village :

Tehsil : Nagpur City Location Area : Urban
NAGPUR
Address (House
TANDAPETH LAL DARWAJA EKNATH WADI NAGPUR Pili Mata Chowk
no,street/area/suburb Pin Code : 440017
Nagpur
etc.) :
Permanent Address :
City/Town/Village :
State राज्य : Maharashtra District : Nagpur Tehsil : Nagpur City Location Area : Urban
NAGPUR
TANDAPETH LAL DARWAJA EKNATH WADI NAGPUR Pili Mata Chowk
Address : Pin Code : 440017
Nagpur
Contact details
Mobile Email ID ई - मेल आयडी:
7249837670
Number wakodikarkhushi@gmail.com
2.Legal Reservation Information
Category Type : Category जातीचा प्रकार
Sub Category पोटजातीचा प्रकार : KOSHTI
Reserved : SBC
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)?  Yes
3.Social Information(Additional Inforamtion)
University staff/family member
Paper Selected for:
First Semester
 1T6 - Supplemetry English 1T24 - Biochemistry -I
1T25 - Biochemistry-II 1T26 - Biochemistry PRACTICAL
1T27 - Biotechnology-I 1T28 - Biotechnology-II
1T29 - Biotechnology PRACTICAL 1T66 - Chemistry-I
1T67 - Chemistry-II 1T68 - Chemistry PRACTICAL
1T1 - Compulsory English

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian पालकाचा व्यवसाय : Service Annual Income of Guardian पालकाचे वार्षिक उत्पन्न : 80000
5.Educational Details
Month Out
Name of Name of Board/University and Name of and Year Exam Certificate Mark Of
Examination State of University School/College of Seat No. No. Obtained एकू ण CGPA %
Passing गुण
MAHARASHTRA STATE BOARD
OF SECONDARY AND HIGHER
Std 10th -- -- 415.00 500.00 --
-
-- 83.00
SECONDARY
EDUCATION,Maharashtra
Std 12th
N039668 53327 373.00 650.00 --
-
-- 57.38
Science
Your Last Qualifying Exam: HSC/Std 12th [Science]
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Leaving Certificate.

Statement of Marks of Std 10th

Self affidavit regarding gap in academic year (Gap Certificate)

Caste Validity Certificate

Certificate of Caste with Category.

Passing Certificate of Std 12th / Statement of Marks of Std 12th.

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 :18128
(KHUSHI SUNIL WAKODIKAR)
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.

Please submit necessary documentary evidence at the time of submission of this application form at the concerned
Faculty/College

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 Tue Dec 07 2021 19:44:13 GMT+0530 (India Standard Time)