Application ID.

: S231132 AY: 2023- 2024

ABC ID
(To be written at the time of Admission.)

Application ID.: S231132

Merit List No: Sr.No:

Date: 12-Jun-2023 AY: 2023- 2024

For office use only

Program Admitted to:
Faculty:
Class:
Signature of Member of Admission
Division: Roll No:
Committee

Name:
Date:

Admission Details
Selected Programs F. Y. BMS (XII Arts/ Com./ Sci./ MCVC 1st Attempt pass required)
F. Y. BSc (Computer Sci.) (XII - Science with Mathematics and Statistics)

Concession: SC/ST/NT/DT/VJ/SBC/OBC/EBC/PTC/SSTC/Ex-Serviceman/Paying

Subjects: SEM I SEM II

Sr. No. Subject Sr. No. Subject
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10

Personal Information Last Name First Name Middle Name

Name of the Student SURVE VINIT RAVINDRA

विद्यार्थ्यांचे नाव (देवनागरी) सुर्वे विनित रवींद्र

Father's/Husband's Name SURVE RAVINDRA DATTARAM

Mother Name SURVE ARCHANA RAVINDRA

Previous Name of Student (In case

of changed name)

Reason for Name Change: NA Marital Status: UNMARRIED Admission Status: Fresh

खुल्या प्रवर्गातील आर्थिकदृष्ट्या दुर्बल घटक (EWS) : No

इतर आरक्षण : NA

F.Y. साठी यापूर्वी या महाविद्यालयात किं वा इतरत्र प्रवेश घेतला होता का?: No

प्रवेश घेतलेल्या कनिष्ठ महाविद्यालयाचे नाव : NA

Birth Date: 04-07-2005 Birth Place: RATNAGIRI Age: 17 Blood Group:

Gender: MALE Nationality: INDIAN Domicile of State: Maharashtra (MH)

Religion: HINDU Caste: OPEN Category: Open

Email: sohamsurve5577@gmail.com Aadhar Card Number: 785059759875 Physically Handicapped: No

Contact Details
Local Address For Correspondence: 572 BAZARPETH RAJAPUR
Landmark: Taluka: RAJAPUR District: Ratnagiri

Gogate Jogalekar College, Ratnagiri

 Application ID.: S231132 AY: 2023- 2024

State: Maharashtra (MH) Pin Code: 416702

Permanent Address: 572 BAZARPETH RAJAPUR

Landmark: Taluka: RAJAPUR District: Ratnagiri
State: Maharashtra (MH) Pin Code: 416702

Mobile Number(Own): 8554987755 Phone Number:

Last Years Educational Details

Name Of Board/University: MAHARASHTRA STATE BOARD OF SECONDARY Name Of School/College: RAJAPUR HIGHSCHOOL RAJAPUR, TAL RAJAPUR,
AND HIGHER SECONDARY EDUCATION DIST RATNAGIRI

12th Passed Branch : Science Class: XII Division: NA Roll No.: NA

Examination Seat No.: W003464 Mark Sheet No.: Passing Month/Year: May/2023

Student Id: 2015273207170120210 U-DIAS No. : 27320717012

Obtained Marks: 283 Total Marks: 600 Percentages: 47.17% Result: PASS No. Of Attempts: 1

Concession( SC/ST/NT/DT/VJ/SBC/OBC/EBC/PTC/SSTC/Ex- Scholarship: NA

Serviceman/Paying): Paying

Attached Document & Certificates

Sr. No. Name of Document/Certificate Original & True Copy Attached(Yes/No)
1 Statement of Marks of previous Exam Original & True Copy
2 Leaving Certificate Original
3 Certificate of Caste with category Original & True Copy(if available)
4 Non-creamylayer Certificate Original & True Copy(if available)
5 Concession form if applicable
6 Xerox of Aadhar Card

Father/Guardian Information
Guardian Name (Father/Mother): RAVINDRA DATTARAM SURVE Occupation of the Father/Mother: Service

Annual Income of the Father/Mother(₹): 150000.00 Relationship of Guardian with Applicant: FATHER

Mobile Number of the Father/Guardian: 9370889099 Phone Number of the Father/Guardian:

Guardian Address: 572 BAZARPETH RAJAPUR

Landmark: Taluka: RAJAPUR District: Ratnagiri
State: Maharashtra (MH) Pin Code: 416702

Other Details
Mother Tongue: Marathi Personal Identification Marks:

University Reference No. : 1424832, 1425951 Employment Status: Unemployed

Bank Of Maharashtra A/C No.: Branch As Per Passbook:

Declaration
Declaration by Student:
I hereby declare that, I have read the rules related to admission, attendance, examination, fees mentioned in the prospectus and the information filled In by me
in this form is accurate and true to the best of my knowledge. I undertake that, I will be responsible for any discrepancy arising out of the form signed by me. I
know that, in the absence of any document, the final admission will not be granted and/or admission will stand cancelled. I have read the eligibility criterion for
the course for which admission is taken and I also know that, If I am not eligible, my admission stands cancelled.
मी याद्वारे जाहीर करते/करतो की, प्रवेश, उपस्थिती, परीक्षा, फी संबंधीचे विद्यार्थी हस्तपुस्तकामधील नियम मी वाचले आहेत आणि या फॉर्ममध्ये, मी भरलेली माहिती, माझ्या माहितीत अचूक आणि सत्य आहे. मी स्वाक्षरी
के लेल्या फॉर्ममुळे उद्भवणाऱ्या कोणत्याही विसंगतीसाठी मी जबाबदार राहीन. कोणत्याही कागदपत्राच्या अनुपस्थितीत अंतिम प्रवेश दिला जाणार नाही आणि/किं वा प्रवेश रद्द होईल, याची मला जाणीव आहे. ज्या
कोर्ससाठी प्रवेश घ्यावयचा आहे, त्याचे पात्रता निकष मी वाचले आहेत आणि मी पात्र नसल्यास माझा प्रवेश रद्द के ला जाईल, याचीही मला जाणीव आहे.

Declaration by Father/Guardian:
I have permitted my son/daughter/ward to join your college. The information we have supplied is correct to the best of my knowledge. I have acquainted myself
with the rules, and regulations regarding attendance, examinations, fees and further. I, also undertake to follow all the rules and regulations as mentioned in the
prospectus, otherwise his/her admission will be cancelled, for which I agree.
मी माझ्या मुलाला/मुलीला/पाल्याला तुमच्या महाविद्यालयामध्ये दाखल होण्याची परवानगी दिली आहे. आम्ही पुरविलेली माहिती माझ्या माहितीत योग्य आहे. हजेरी, परीक्षा, फी, इत्यादी, संबंधीचे नियम व कायद्यांची
माहिती मी करून घेतली आहे. विद्यार्थी हस्तपुस्तकामध्ये नमूद के ल्याप्रमाणे सर्व नियम व कायद्यांचे पालन करण्याची जबाबदारी मी घेतो, अन्यथा त्याचा/तिचा प्रवेश रद्द होईल, ज्यासाठी मी सहमत आहे.
Signature of the Student Signature of Father/Guardian

Date: Date:

Place: Place:

Gogate Jogalekar College, Ratnagiri

 Application ID.: S231132 AY: 2023- 2024

Gogate Jogalekar College, Ratnagiri