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Application Form for Cancellation of Admission to First Year Under

Graduate Technical Courses in Engineering and Technology (4 Years) &


Master of Engineering and Technology (Integrated 5 Years) Admissions
A.Y. 2022-23

Application ID : EN22133550

Personal Details

Candidate Name JAGANI JAINAM BHAVESH

Gender Male Date Of Birth 18/02/2004

Admission Details

Institute Name 3182 - Thadomal Shahani Engineering College, Bandra, Mumbai

Course Name 318299510 - Artificial Intelligence and Data Science

Seat Type AI Preference No. 18

Date of Admission 10/11/2022 Admitted Through CAP

Fee Details

Sr. Payment Fee DD/Cheque Payment


Bank Name Branch Name
No. Mode Amount Number Date

DD /
1. 176312 001805 10/11/2022 Bank of India borivli
Cheque

          
I request you to kindly return my original documents and refund the fees paid as per the rules.

Place :                        Date :

Online Cancelled On : 16/11/2022 12:15:05 PM


Signature of Candidate

Printed On : 16/11/2022 12:15:33 PM (JAGANI JAINAM BHAVESH )

For Office Use Only

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