सतीश प्रधान ज्ञानसाधना महािवद्यालय, ठाणे Application No.

Satish Pradhan Dnyanasadhana College, Thane

UA-5043
F.Y.B.M.S. - (2023-2024)

DATA VARIFICATION/ मािहतीचे सत्यापन

Attach and tick the applicable documents

Photocopy / Xerox of Lastest Marksheets

Professor / Teacher Signature &
Photocopy / Xerox of Caste Certificate (If applicable) Date

ACADEMIC RECORD/ शैक्षिणक मािहती

GPA/Marks Obtained /
Board / College Examination Exam. Seat No.
Maximum GPA/Marks

Maharashtra State Board of SSC

S.Y.J.C. (Commerce) M161874 364/600
and HSC

COURSE PREFERENCES/ िवषय प्राधान्य

Subjects Preference: -- All Courses Compulsory --

Certificate Courses Opted: ///////////

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 PROGRAM & CANDIDATE'S PERSONAL INFORMATION/ अभ्यासक्रम व वैयिक्तक मािहती

GI No. / Prospectus
24842 / 2332043
Number

Academic Year / Program

2023-2024 / F.Y.B.M.S.
Admitted

Candidate's Full Name Kulkarni Yash Pandurang

Gender / Birth Date / Birth

Place / Blood Group / Male / 18-Apr-2005 / Kinhavali / A / Thane
Native Place

Email Address & Mobile yashkulkarni163@gmail.com / 7506180362

No. 9152258558

Candidate's Aadhar No.

4603-3185-9743 / Indian
(UIDAI) / Nationality

Religion / Mother Tounge Hinduism / Marathi

Quota / Quota Description General /

Category / Caste / Sub-

Caste / Caste Certificate General / Open / /
No. Candidates Signature:

Previous School with Satish Pradhan Dnyanasadhana College / E.E. Highway, Sathe Wadi, Thane -
Address: 400604.

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 FAMILY INFORMATION/ कौटुंिबक मािहती

Father's Full Name: Pandurang Bhaurao Kulkarni

Father's Education: 10th Standard

Father's Occupation: Private Service

Mother's Maiden Name Jyoti Pandurang Kulkarni

Mother's Education 10th Standard

Mother's Occupation -- Not Working --

Family Income Range 6000 to 20000 per month

Mother / Father Aadhar

272955151223 578086912945
No. (UIDAI)

Parents Mobile Numbers &

8976748041 9029991670 7045428656 / 8591927693
Land Line Numbers

Parents Mobile Numbers &

kulkarnij41@gmail.com
Email

BHINAR POST DOLKHAMB TALUKA SHAHAPUR JILLA THANE BHINAR

Correspondence Address
DOLKHAMB THANE MAHARASHTRA 421601

Taluka / District / State

Shahapur / Thane / Maharashtra / India / 421601
and Country / Pin Code

BHINAR POST DOLKHAMB TALUKA SHAHAPUR JILLA THANE BHINAR DOLKHAMB

Native Address
THANE MAHARASHTRA 421601

Land Line / Mobile

7506180362
Numbers

PREVIOUS SCHOOL OR COLLEGE/ आधीची शाळा िकंवा महािवद्यालय

Previous School-College Name with Address: Satish Pradhan Dnyanasadhana College / E.E. Highway,
Sathe Wadi, Thane - 400604.

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 University of Mumbai

DECLARATION /UNDERTAKING FROM THE STUDENT

I, Mr./Ms. Kulkarni Yash Pandurang bearing Mobile No: 7506180362 9152258558 and
Email Address:yashkulkarni163@gmail.com. Here by declare that, information submitted in
admission form is correct. I am confirming my admission for course F.Y.B.M.S. at college
Satish Pradhan Dnyanasadhana College, Thane for academic year 2021-2022. My
registration no of Mumbai University digital portal is PRN-1534798

I agree that:
1. I will not confirm my admission to any other college.
2. I will submit my all original documents to the college whenever required to do so.
3. I am aware that if my admission form is found to be wrongand/or if it is known that I have
submitted my original document to any other college, my admission will be treated as canceled.

DECLARATION BY PARENT/GUARDIAN

I Pandurang Bhaurao Kulkarni / Jyoti Pandurang Kulkarni, (Mother/Father/Guardian) Hereby

fully endorde the above declaration/undertaking given by my child/ward. I will further encourage
my child/ward to do his/her best to observe the above stated undertaking in letter and spirit.

UNDERTAKING

I Kulkarni Yash Pandurang state that I shall attend all the lectures regularly; I shall maintain
75% attendance in all the subjects. In case I fail to do so, I may not be given admission to the
Second Term or may not be allowed to appear for the College / University Examination. The
information provided in this application form is correct. In case of any issues arise in the future I
will remain responsible for it. I have read the rules in the Prospectus and will abide by it.

I agree with above given DECLARATION, UNDERTAKING.

42.106.240.188 2023-07-10 01:54:12 PM

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