6/11/23, 8:44 PM about:blank

For Office Use

Batch: Scrutiny Payment: Online/DD PI

Only Serial:

Vivekanand Education Societys College of Arts, Science and Commerce (345)

Sindhi Society, Chembur Kurla Application No :
University of Mumbai 1238914
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
Academic Year: 2023-2024
Regular
APPLICATION FORM

Course Applied for : B.Sc. (I.T.) (Autonomous)(with Credits) - Regular - CBCS - ABC ID: 678-371-229-562 PRN:
F.Y.B.Sc. (I.T.) (Autonomous) Sem I  (-)

Application Date : 11/06/2023 Payment Category :

1.Personal Information

Candidate's Name(Regional) : राय शिवम मनीष कु मार

Candidate's Name as printed on
Mark sheet :
Father's/Husband's Name :
Marital Status :
Place Of Birth : Mumbai
Blood Group :
Is Student NRI/ Foreign National : No
Address For Correspondence :
State : Maharashtra
Address (House
T-1 Pl Lokhande Marg Chembur
no,street/area/suburb etc.) :
Permanent Address :
State : Maharashtra
Address :
Contact details
Mobile Number 8286894441
2.Legal Reservation Information
Category Type : Open
Is Specially Abled? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem I
BSC IT 1.1 - Paper 1
BSC IT 1.3 - Paper 3
Sem II
RAI SHIVAM MANISH KUMAR
[*This name will appear on all University records/documents]
MANISH Mother's Name : ANJU
Mother Tongue :
Gender : Male Date of Birth (DD/MM/YYYY) : 25/08/2005
Religion : Hindu Country of Citizenship : India
Domicile State: Maharashtra
City/Town/Village :
District : Mumbai Suburban Tehsil : Kurla Location Area : Urban
Mumbai
Pin Code : 400089
City/Town/Village :
District : Mumbai Suburban Tehsil : Kurla Location Area : Urban
Mumbai
T-1 Pl Lokhande Marg Chembur Pin Code : 400089
Email ID: rai25082005@gmail.com
Category : GEN
Is Guardian from EBC (Economic Backward
Class)?  No
BSC IT 1.2 - Paper 2
BSC IT 1.4 - Paper 4

BSC IT 2.1 - Paper 1 BSC IT 2.2 - Paper 2

BSC IT 2.3 - Paper 3 BSC IT 2.4 - Paper 4

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Business Annual Income of Guardian : 0
5.Educational Details
Month
Name of Name of Board/University and State Name of Exam Certificate Mark
and Year Out of CGPA %
Examination of University School/College Seat No. No. Obtained
of Passing
MAHARASHTRA STATE BOARD
SHREE BD SHUKLA
OF SECONDARY AND HIGHER March
Std 10th ENGLISH HIGH A323385 351081 416.00 500.00 -- - -- 83.20
SECONDARY 2021
SCHOOL
EDUCATION,Maharashtra

about:blank 1/2
6/11/23, 8:44 PM about:blank

Month
Name of Name of Board/University and State Name of Exam Certificate Mark
and Year Out of CGPA %
Examination of University School/College Seat No. No. Obtained
of Passing
MAHARASHTRA STATE BOARD SHREE SANATAN
Std 12th OF SECONDARY AND HIGHER DHARAM
May 2023 M099277 312081 351.00 600.00 -- - -- 58.50
Science SECONDARY VIDYALAYA AND
EDUCATION,Maharashtra JR COLLEGE
Your Last Qualifying Exam: HSC/Std 12th [Science]
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.

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 :1238914 (RAI SHIVAM MANISH KUMAR) 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 Sun Jun 11 2023 20:44:20 GMT+0530 (India Standard Time)

about:blank 2/2