Savitribai Phule Pune University

Swargeeya Sanjibhai Rupjibhai Memorial Trust's

S.S.R. College Of Arts, Commerce & Science
Sayli Road, Silvassa – 396230
Contact : 9081160001 / 9904301084 / 9860552895 / ---- / ---- / Email : ssrcollegeacs2006@rediffmail.com

Admission Form Details (Academic Year : 2023-24)

Verification Signature Division Roll No G.R. No

Scholarship Verification Signature Category Caste Sub Caste

Fee Collection Clerk's Signature Rcpt. No. Amount Date

Bank Name Branch DD No. Prv. Class/Attend

Registration Information Date : 19/07/2023 05:53 PM

Admission Form Number : 1947822

Registration Number : 2100175133

Admission Type : Section : Class :

Provisional U.G. S.Y.BA.
Division : Fee Category : Caste Category :
P.N.G. PAYING S.T.
Eligibility No.(UG & PG) : Adhaar Card No. : Voter ID. :
12022148542 785063414673 N.A.

Student's Information

Student's Name : Gender :

DRUTI PATEL Female
Student's Email ID : Student's Mobile :
drutipatel848@gmail.com 7433095034
Adress Line 1 :
H.NO-10401,MASAT,PADRI FALIYA,SILVASSA,DNH
Adress Line 2 :
H.NO-10401,MASAT,PADRI FALIYA,SILVASSA,DNH
Location : Taluka : District :
Masat Dadra & Nagar Haveli Valsad

S.S.R. College Of Arts, Commerce & Science (Form No:1947822) Page 1

State : Country : Pin Code :
Gujarat INDIA 396230
Student's Phone 1 : Student's Phone 2 : Student's Birth Date :
7433095034 7433095034 30/10/2003
Student's Birth Place : Nationality : Mother Tongue :
SILVASSA INDIAN Gujarati
Marital Status : Occupational Status : Blood Group :
Single Unemployed A+
Handicap : Is Organ Donor : Conveyance Use :
N.A. No. Two Wheeler
Religion : Caste : Sub Caste :
HINDU DHODIA HINDU
Caste Category : Caste Validity No. : Is Minority :
S.T. N.A. No
Minority Detail :
N.A.

Parent's Information

Father's Name :
DAYARAM DAJIBHAI PATEL
Mother's Name :
BHAVNABEN D PATEL
Parent's Email : Father's Mobile :
dayarampatel7481@gmail.com 7359383510
Parents Address Line 1 :
H.NO-10401,MASAT,PADRI FALIYA,SILVASSA,DNH
Parents Address Line 2 :
H.NO-10401,MASAT,PADRI FALIYA,SILVASSA,DNH
Location : Taluka : District :
Masat Dadra & Nagar Haveli Valsad
State : Country : Pin Code :
Gujarat INDIA 396230
Location Type : Mother's Mobile : Parent's Phone :
Urban 7285880534 7359383510
Parent's Profession : Parent's Occupation :
TRANSPORT BUSINESS Business
Nominee's Location :
N.A.
Relation with Nominee :
N.A.
Age of Nominee :

Guardian's Information

S.S.R. College Of Arts, Commerce & Science (Form No:1947822) Page 2

Guardian's Name :
DAYARAM DAJIBHAI PATEL
Relation : Guardian's Mobile : Guardian's Phone :
Father 7359383510 7359383510
Guardian's Email :
dayarampatel7481@gmail.com
Guardian's Address Line 1 :
H.NO-10401,MASAT,PADRI FALIYA,SILVASSA,DNH
Guardian's Address Line 2 :
H.NO-10401,MASAT,PADRI FALIYA,SILVASSA,DNH
Location : Taluka : District :
Masat Dadra & Nagar Haveli Valsad
State : Country : Pin Code :
Gujarat INDIA 396230

Parent's Company/Occupation Information

Company Name :
BHAVNABEN D PATEL TRANSPOT SERVICE
Company Address Line 1 :
H.NO-10401,MASAT,PADRI FALIYA,SILVASSA,DNH
Company Address Line2 :
H.NO-10401,MASAT,PADRI FALIYA,SILVASSA,DNH
Location: Taluka: District:
Masat Dadra & Nagar Haveli Valsad
State : Country : Pin Code :
Gujarat INDIA 396230
Mobile No. :
N.A.
Last Year's Details with (TC/LC)/Migration/Eligibility Information
Last Attended Class : Last Year College/School UDISE Code :
FY BA N.A.
Last Attended Institute Name :
SSR COLLEGE OF ARTS,COMMERCE & SCIENCE
Last Examining Body (Board/University) :
SPPU
Eligibility : State of Residence : Last Qualified Exam :
Same Institute/College O.M.S. SEM2 FY BA
Passing Month : Passing Year : Percentage :
May 2023 N.A.
Result : Attempt : Exam Center :
A+ Grade 1st 0821
Seat No. : T.C./L.C. No. : T.C./L.C. Date :
N.A. N.A. N.A.

S.S.R. College Of Arts, Commerce & Science (Form No:1947822) Page 3

Migration Cert. No. : Migration Cert. Issue Date : Gap :
N.A. N.A. No
F.Y. SGPA Semester 1 : F.Y. Earned Credit Semester 1 : F.Y. Out of Credit Semester 1:
N.A. N.A. N.A.
F.Y. Credit Points Semester 1 : F.Y. SGPA Semester 2 : F.Y. Earned Credit Semester 2 :
N.A. N.A. N.A.
FY_Earned_Credit_1 : F.Y. Out of Credit Semester 2 : F.Y. Total Earned Credits :
N.A. N.A. N.A.
F.Y. Total Out of Credits : F.Y. Total Credits Points : F.Y. CGPA :
N.A. N.A. N.A.
Current Year's Information :
Availed Earn and Learn Scheme : Are From Dushkalgrast Area :
No N.A.
Extra Curr.Activ. Interested : Consession Information :
N.A.
Passport Information :
Passport Type : Country : Country Code :
N.A. N.A. N.A.
Passport No : Place of Issue : Issue Date :
N.A. N.A. N.A.
Expiry Date : Visa No : Nature of Visa :
N.A. N.A. N.A.
Isued at : No. of Entries : Visa Issue Date :
N.A. N.A. N.A.
Visa Expiry Date : University Letter No. : University Letter Date :
N.A. N.A. N.A.
University ID No. : R. P. No. : R. P. Valid From :
N.A. N.A. N.A.
R. P. Valid Till : FSIS ID :
N.A. N.A.
Subjects :
Subject Group Subject Name Subject Code
Sub-Group - AAB1 1) HISTORY GENERAL PAPER-2 (23174) 23174
Sub-Group - AAB1 2) HISTORY GENERAL PAPER-2 (24174) 24174
Sub-Group - AAC1 3) PSYCHOLOGY GENERAL PAPER-2 (23223) 23223
Sub-Group - AAC1 4) PSYCHOLOGY GENERAL PAPER-2 (24223) 24223
Subject Group - A 5) Compulspory English (23001) 23001
Subject Group - A 6) HINDI BHASHA SHIKSHAN-1 (23012) 23012
Subject Group - A 7) ECONOMICS SPECIAL PAPER-1 (23151) 23151
Subject Group - A 8) ECONOMICS SPECIAL PAPER-2 (23152) 23152
Subject Group - A 9) ECONOMICS GENERAL PAPER-2 (23153) 23153
Subject Group - A 10) ECONOMICS SEC 2 (23154) 23154

S.S.R. College Of Arts, Commerce & Science (Form No:1947822) Page 4

Subject Group - A 11) ENVIRONMENTAL SCIENCE-1 (23999) 23999
Subject Group - A 12) Compulsory English (24001) 24001
Subject Group - A 13) HINDI BHASHA SHIKSHAN-2 (24012) 24012
Subject Group - A 14) ECONOMICS SPECIAL PAPER-1 (24151) 24151
Subject Group - A 15) ECONOMICS SPECIAL PAPER-2 (24152) 24152
Subject Group - A 16) ECONOMICS GENERAL PAPER-2 (24153) 24153
Subject Group - A 17) ECONOMICS SEC 2 (24154) 24154
Subject Group - A 18) ENVIRONMENTAL SCIENCE-2 (24999) 24999
Documents Attached :
Previous Educational Qualification Details :
1) Institute Name : SSR COLLEGE OF ARTS COMMERCE AND SCIENCE
Board/Uniersity Name : SPPU PUNE UNIVERSITY
Qualified Course : Passing Year : 2023
F.Y.B.A.
Passing Month : May Obtained Marks : Maximum Marks :
Percentage : Grade : A+ Grade Attempt : 1st
2) Institute Name :
Board/Uniersity Name :
Qualified Course : Passing Year :
Passing Month : Obtained Marks : Maximum Marks :
Percentage : Grade : Attempt :
3) Institute Name :
Board/Uniersity Name :
Qualified Course : Passing Year :
Passing Month : Obtained Marks : Maximum Marks :
Percentage : Grade : Attempt :

DRUTI PATEL
Student's Signature

Undertaking

S.S.R. College Of Arts, Commerce & Science (Form No:1947822) Page 5

 We hereby certify that the information provided in this application form is correct. We undertake
to abide by the rules and regulations of the college and the orders issued by the competent authorities
from time to time. We are agree that decision of the principal in respect of the student’s admission will be
binding upon us.

Student's Signature Parent's Signature

Principal's/Vice Principal's/Director's/Authority Signature Admission Admission Not

S.S.R. College Of Arts, Commerce & Science Confirmed Confirmed

S.S.R. College Of Arts, Commerce & Science (Form No:1947822) Page 6