Form No.

______
JALNA EDUCATION SOCIETY'S
R.G. BAGDIA ARTS, S.B. LAKHOTIA COMMERCE &
R. BEZONJI SCIENCE COLLEGE, JALNA.
Form of Registration for Admission to the College : 2021-2022

To,
The Principal,
J.E.S. COLLEGE,JALNA
Sir,
I hereby apply for registration to the _M.SC FIRST YEAR CHEMISTRY _ class of your college.
PERSONAL INFORMATION FULL NAME(in capital letters) Students's Signature4

in English MASKE DHIRAJ BABURAO

in Devnagari DHIRAJ BABURAO MASKE

Last Name First Name Middle Name

Father's Full Name BABURAO DAMODAR MASKE

Mother's Full Name KUSUM BABURAO MASKE

Gender :MALE Aadhar No. 461302356368

Permanent Address INDRAPRASTH NAGAR, B AND C QUARTERS, JALNA

District :JALNA City/Town :JALNA

Contact Details 9518529842 Mobile No. :9518529842

Email ID: DHIRAJMASKEICT2@GMAIL.COM Date Of Birth 30-Sep-2021

Occupation of Father/Guardian SERVICE Annual Income :525744

Social Reservation RESERVED Caste Category :SC

Caste MAHAR Whether Physically Challenged NO

LAST EDUCATIONAL DETAILS
Last Exam: BACHELOR OF CHEMICAL ENGINEERING
Last School/College : INSTITUTE OF CHEMICAL TECHNOLOGY
Last Passing Date : 2015 Number of Attempts : 1
Marks Obtained: 6 Maths Marks: 0
Total Marks: 10 Science Marks: 0
Percentage : 60 CET 0
NSQF NO Sports Quota NO Elementry Exam NO

The information given herewith is correct as per my knowledge. If the above information given by me is wrong, I
should be liable for cancellation of admission process. I have attached my relevant documents for your verification.

Yours' Faithfully,
Place: ___________
Date: ___________
(Signature of Student)

Mob. .....................................