SYMBIOSIS COLLEGE OF ARTS AND COMMERCE, AN AUTONOMOUS COLLEGE, UNDER SAVITRIBAI PHULE PUNE UNIVERSITY ‘SENAPATI BAPAT ROAD, PUNE - 411 004 regi gee ‘Application Form for Eligibility - 2022 - 2023 Name ofthe Student- Thakral Badal Rajkumar {in English Capital Letters) (Last Name) (First Name) (Middle Name) Name as per last Mark sheet should be mentioned Class: FY.B.Com. Divs C RollNo:- 4501 PRN No:- F8C-22-23-4501 | wish to apply for Eligibility in the academic year 2022 - 2023 Personal Details Permanent Address:- _ thakralniwas,ram mandir road kopargaon,42360", Kopargaon, Maharashtra, 423601 Local Address:- sal vishwa,HHH hanuman nagar.senapati bapat road pune,411016, pune, Maharashtra, 411016 Domicile State:- Maharashtra Mother's Name:- pooja ‘AadharNo- — 6XXXxXN00K074 Mobile No.: 9087114913 PAN No.:+ Email ID:- BADALSTO13@GMAIL.COM Type: Nationality:- Indian Religion:- Hindu Gender: Male Date of Birth:- 04/02/2005, Birth Place: panded Caste Category: Open Birth State:- Quota: (iF you belong to any of the Reserved Category, please attach a certificate of a Competent Authority in support of it) (Po you belong to DT(A), NT(B),NT(C).NT(0), OBC, SBS,SEBC or EWS ? YesiNo Physically Disabled? Yes/No (If Yes please specty type) [Examination Details Name of the Exam, (HSC Maharashtra) Class: 12th BoardiUniversity Board State:- Duration of the Course:- Name of the CollegelInstitute:- __Sanjivani jr college Page 1 of 2sean a ower percentage paar Aree #5 #00 nam Fase Spi Editon Gap dtl any Last Examination ‘Seat No. Month & Year of Marks Obt. Out of Percentage Name Passing Do you belong to the Minority? Yes/No (if yes please specify type which has given below) Linguistic] Religion: [Documents to Attach 1)Marksheet 2) Migration 3) Leaving/Transfer 4) Passing ©—«§) Gap Affidavit 6) Caste Cerificate 7) Gazette for Name Change 8) Domicile Certifcate 9) Caste Validity Certificate [Dectaration | undersigned certy that, I have read rules of Eligbilty and admission is made according to the rules. | am responsible for any discrepancy, error or incomplete information in admission and Elgibilty form. | understand that til Eligibility Certificate from the UniversityiCollege is obtained my admission wil remain provisional at the cost and risk of me. Decision of the University / College in respect of Eligibility shall be final Date:- 24-Aug-2022 i 1920: Signature of Student For Office Use Only ‘Transaction ID NO. Date: Eligible:-Yes( )/No( ) Discrepancy:- 1) 2) 3) Senior Clerk/Head Clerk Junior Clerk. Principal Office SuperintendentRegistrar Symbiosis College of Arts and Commerce Date:- Place:- Pune Page 2 of 2