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Birla College of Arts, Science and Commerce (23)

Birla College Road.

Kalyan
Application No :

University of Mumbai 2564225

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

Academic Year: 2022-2023

Regular
APPLICATION FORM

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

Application Date : 08/09/2022 Payment Category :

1.Personal Information

Candidate's Name(Regional) : खैरे अथर्व अनिल

Candidate's Name as printed on Mark KHAIRE ATHARVA ANIL
sheet : [*This name will appear on all University records/documents]

Father's/Husband's Name : ANIL Mother's Name : MEERA

Marital Status : UnMarried Mother Tongue : Marathi

Place Of Birth : SOLAPUR Gender : Male Date of Birth (DD/MM/YYYY) : 25/09/2003
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 DATTATRAY COLONY ACHANAK SOCIETY CHAWL NO 6 ROOM NO 10 BIRLA
Pin Code : 421301
no,street/area/suburb etc.) : COLLEGE KALYAN WEST
Permanent Address :
City/Town/Village :
State : Maharashtra District : Thane Tehsil : Kalyan Location Area : Urban
KALYAN
DATTATRAY COLONY ACHANAK SOCIETY CHAWL NO 6 ROOM NO 10 BIRLA
Address : Pin Code : 421301
COLLEGE KALYAN WEST
Contact details
Mobile Number 7738556631 Email ID: athukhaire5566@gmail.com
2.Legal Reservation Information
Category Type :
Category : SC Sub Category : BURUD
Reserved
Is Guardian from EBC (Economic Backward
Is Specially Abled? No
Class)?  No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem I
BBI1001 - Paper 1 BBI1002 - Paper 2
BBI1003 - Paper 3 BBI1004 - Paper 4
Sem II

BBI2001 - Paper 1 BBI2002 - Paper 2

BBI2003 - Paper 3 BBI2004 - Paper 4

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Laborer Annual Income of Guardian : 50000
5.Educational Details
Month
Name of Name of Board/University and State of Name of Exam Certificate Mark
and Year Out of CGPA %
Examination University School/College Seat No. No. Obtained
of Passing
 Month
Name of Name of Board/University and State of Name of Exam Certificate Mark
and Year Out of CGPA %
Examination University School/College Seat No. No. Obtained
of Passing
MAHARASHTRA STATE BOARD OF
NUTAN March
Std 10th SECONDARY AND HIGHER A061473 -- 329.00 500.00 --
-
-- 65.80
VIDYALAY 2019
SECONDARY EDUCATION,Maharashtra
MAHARASHTRA STATE BOARD OF B.K.BIRLA
Std 12th March
SECONDARY AND HIGHER COLLEGE M147875 -- 454.00 600.00 --
-
-- 75.67
Commerce 2021
SECONDARY EDUCATION,Maharashtra KALYAN WEST
Your Last Qualifying Exam: HSC/Std 12th [Commerce]
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.

Certificate of Caste with Category.

Leaving Certificate.

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 :2564225 (KHAIRE ATHARVA ANIL)
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 Remarks / Particulars / Recommendations Signature and Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: INR Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Thu Sep 08 2022 18:15:12 GMT+0530 (India Standard Time)