INSTITUTE OF CHEMICAL TECHNOLOGY

Institute Of Chemical Technology

N.M.Parekh Marg, Matunga, Mumbai 400019 India.
Ph: +91-22-33611111/2222, Fax: +91-22-33611020, www.ictmumbai.edu.in

2023 - 24
Form No.- Ph.D (Tech) - Chemical
Engineering-1013
Personal Information
Full Name SUMIT SANJAY POTDAR
DOB Oct 15,1993 Gender MALE
Email Id sumitpotdar3@gmail.com Mother's Name ASHA
State of Domicile MAHARASHTRA Applicant Registered 9529303734
Mobile Number
Alternate Contact No 7385400766 Religion HINDU
Caste SONAR Sub Caste
Mother Tongue MARATHI Admission Quota Type: Reserved
Reserve Category: OBC Blood group O+
Place of Birth Ashta
Adhaar Card Number 770587302027
Nationality Indian
Marital Status Married
Residence Address Details
Residence Address CHAVANWADI, NEAR CHITALE DAIRY
Country INDIA Permanent Address State MAHARASHTRA
City/District Pin 416301
SANGLI
Taluka Village VALVA
VALVA
Permanent Address Details
Permanent Address CHAVANWADI, NEAR CHITALE DAIRY
Country INDIA Permanent Address State MAHARASHTRA
City/District Pin 416301
SANGLI
Taluka Village VALVA
VALVA
Parent Details
Father's Full Name: Sanjay Bapuso Potdar
Mother's Full Name: Asha
Father's Email ID : sp049917@gmail.com Father's Mobile No. : 7350645412
Mother's Email ID : Mother's Mobile No. :
Address : Ashta Ashta Walva Sangli 416301
Pin Code : 416301
Father's Profession : Farmer Mother's Profession :
Father Annual Income : 100000 Mother Annual Income :
Guardian Details
Guardian Full Name Sanjay Bapuso Potdar
Email ID : sp049917@gmail.com Mobile No. : 7350645412
Address : Ashta Age : 60
Pin Code : 4163011 Relation : Father
Std.X
Total Marks Obtained / 479 / 650 Percentage ( % ) 73.69
Out of
Roll No./ Seat Number F067328 Year of Passing 2009
Board of Examination Maharashtra
Std.XII
Total Marks Obtained / 381 / 600 Percentage ( % ) 63.5
Out of
Year of Passing 2011 Stream SCIENCE
HSC roll no./ Seat No. X016980 Board of Examination MAHARASHTRA STATE BOARD

N.M.PAREKH MARG, MATUNGA, MUMBAI 400019 INDIA. Page 1

PH: +91-22-33611111/2222, FAX: +91-22-33611020, WWW.ICTMUMBAI.EDU.IN
 INSTITUTE OF CHEMICAL TECHNOLOGY

Institute Of Chemical Technology

N.M.Parekh Marg, Matunga, Mumbai 400019 India.
Ph: +91-22-33611111/2222, Fax: +91-22-33611020, www.ictmumbai.edu.in

Subject Total Marks Obtained / Subject Total Marks Obtained /

Out of Out of
Physics 53 / 100 Chemistry 48 / 100
Mathematics 71 / 100 Biology 62 / 100
English 72 / 100
PCM Percentage (%) : 57.33
Graduation Details University Name : Shivaji Universiry, Kolhapur

Grand Total / Out of 1230 / 1600 Percentage ( % ) 76.88

Degree Name B. E. in Chemical Engineering College Name PVPIT
Qualifying Status Completed Year of Passing 2015
Principal subject / Class total 0/0 Class Percentage (%) 0.0
Post Graduation Details University Name : Shivaji University Kolhapur

Grand Total / Out of 1343 / 1775 Percentage ( % ) 75.66

Degree Name M. E. in Chemical Engineering
Qualifying Status Completed
Entrance Details
1. Entrance Exam NON GATE
CAT Score CMAT Score
GMAT Score XAT Score
Form fee details
Payment Mode Online Payment
Transaction No. W8TICQITBKC4ZKN
Amount ( In Rs.) 500.0
Documents attached
1 S.S.C. Board Certificate
2 10+2 Certificate
3 Bachelor Marksheets
4 Master Marksheets
5 Caste Certificate
6 Aadhar Card
Physically Handicapped
Physically Handicapped No
Declaration to be signed by the Applicant:
DECLARATION BY THE APPLICANT

I Sumit Sanjay Potdar have read the instructions given in the Handbook carefully before filling up this form. The information given above is true,
complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect, my admission may be
cancelled without any notice. If admitted, I shall abide by all the rules, regulations and discipline of the Institute. I shall not involve myself in any
ragging or anti-social activities which will not only tarnish my own record but also the institute's image and if I come to know of any such
incidence, I shall report it to the authorities. I will also submit the undertaking regarding the anti-ragging measures, once admitted.

Place :

Date : Jul 11, 2023 11:35 PM

Signature of Candidate

N.M.PAREKH MARG, MATUNGA, MUMBAI 400019 INDIA. Page 2

PH: +91-22-33611111/2222, FAX: +91-22-33611020, WWW.ICTMUMBAI.EDU.IN