State Common Entrance Test Cell, Maharashtra State

Application Form No. AGRIUG21000919 Final Print Form

Photo
Personal Information
Candidate's Name Mr. RUSHIKESH PRALHAD PAYGHAN

Father's/Husband's Name PRALHAD NAMDEV PAYGHAN

Occupation of
GOVERMENT SERVICE
Father/Parent
Address and Contact No. 22A
AADARSH COLONY,
City : DEULGAON RAJA, Pincode : 443204. Passport Size Photo
Taluka : DEULGAON RAJA, District : BULDHANA, Dimensions
State : MAHARASHTRA, (4.5cm X 3.5cm-1.78"
Phone No : - 9067845175, Mobile No : 9067845175,9307382276 X 1.38")
Email : hrushikesha48@gmail.com

Mother's Name MANGALA KISAN BODKHE Signature

Date Of Birth 01/07/2001 Gender MALE

Domicile MAHARASHTRA Domicile Option BY BIRTH

Domicile State(Only For

Out of Maharashtra
Candidate):

Category Details
Category OBC Original Category OBC

Caste BARI Sub Caste

Other Reservations NONE Non Creamy Layer Yes

Entrance Exam Details

Entrance Exam Name Roll No. Application No. Percentile Category
MH-CET(PCB) 2117481331 211047238 76.04236820 OBC
MH-CET(PCM) 0.00000000
JEE 0.00000000
NEET 3106018074 210410001419 38.83937620

Academic Details
HSC/Agriculture Polytechnic
SSC Percentage 83.20 P057568
Exam Seat No.
Name & Address of BABUJI AVHAD JR. COLLEGE,City:PATHERDI,
HSC/Agriculture Polytechnic District:AHMEDNAGAR,State:MAHARASHTRA
passed
Total No. of
Month & Year of Passing 06/2019 1 Faculty SCIENCE
Attempts
Marks in HSC / Diploma / (Max Marks) (Marks Obtained) (Percentage)
Agriculture Polytechnic 650 428 65.85
Physics Chemistry Biology Maths English
Subject wise Marks
56 / 100 61 / 100 57 / 100 0/0 52 / 100
Code of Optional Subjects
Vocational Subject Codes
Form Printed on : 11/14/2021 1:46:33 PM Form Printed IP Address : 106.195.15.68
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Weightage Details Final Print Form Application Form No AGRIUG21000919

B.Tech. B. Tech.
Sr. B.Sc. B.Tech. B.Sc.(Comm
Weightages B.Sc.(Agri) B.Sc.(Hort) B.F.Sc. (Food B.Sc(ABM) (Biotechno
No. (Forestry) (Engg) Sci.)
Tech.) logy)

Village form 7/12 extract /

Khasara for the year 2019-20
1 12 12 12 12 0 0 12 12 12
or 2020-21 issued by the
Talathi / Patwari

Certificate of Landless
Agricultural Labour issued
2 0 0 0 0 0 0 0 0 0
by the Tahasildar / Naib
Tahasildar.

Certificate of Fisherman
3 issued by Tahasildar / Naib 0 0 0 0 0 0 0 0 0
Tahasildar

Certificate Of Agriculturist
4 issued by the Tahasildar / 0 0 0 0 0 0 0 0 0
Naib Tahasildar

N.C.C. B or C Certificate ( Air

5 / Naval / Army wing) issued 0 0 0 0 0 0 0 0 0
by the Commandant (Passed
during XI or XII Standard).

N.S.S. Certificate of 240 hrs. /

6 N.S.S. Special Camp issued 0 0 0 0 0 0 0 0 0
by the competent authority.

Employers Certificate being

son / daughter of
7 0 0 0 0 0 0 0 00 00
Agricultural University /
MCAER employee.

Certificate of Debate / Essay

/ Elocution of state Level
8 0 0 0 0 0 0 0 00 00
Competition issued by
concerned Organisation.
Sport Certificate
9 (International / National / 0 0 0 00 0 0 0 00 00
State / District) Level
Certificate of Diploma in
Agriculture Science of Rural
10 0 0 0 00 0 0 0 00 00
Institute Amaravti or
Wardha.
Certificate of Diploma in
11 0 0 0 00 0 0 0 00 00
Agriculture School.

12 0 0 0 00 0 0 0 00 00

13 0 0 0 00 0 0 0 00 00

14 0 0 0 00 0 0 0 00 00

15 Academic Points (Percentile) 76.04237 76.04237 76.04237 76.04237

76.04237 0 0 76.04237 76.04237 76.04237

16 Weightage Points 12 12 12 12 0 0 12 1212 12

12

17 Total Points 88.04237 88.04237 88.04237 88.04237 88.04237 88.04237

88.04237 88.04237

18 Eligible For Course Yes Yes Yes Yes No No Yes Yes Yes

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 Document Details Final Print Form Application Form No AGRIUG21000919
Yes (√) /
No (×) Details of Certificate / Documents
(i) Domicile Certificate issued by the Competent Authority from Maharashtra, College / School Leaving Certificate containing place of birth from
Maharashtra / Birth Certificate issued by the competent authority from Maharashtra.
(ii) For Other State candidates, Domicile Certificate / Residential Certificate / Residence and date of birth Certificate issued from the competent
authority.
Mark sheet of MHT-CET(PCB) common entrance examination.
Mark sheet of MHT-CET(PCM) common entrance examination.
Mark sheet of JEE common entrance examination.
Mark sheet of NEET common entrance examination.
HSC [XII- Std. Science] Mark Sheet / Statement of Marks (If percentage obtained is not mentioned in 12th Std (Science) marksheet, then signed
letter from Principal of concern college mentioning percentage in marksheet)
SSC(X) Std. Mark sheet / Statement of marks(If percentage obtained is not mentioned in Xth Std marksheet then signed letter from Principal of concern college
mentioning percentage in marksheet)
(i) College Leaving/Transfer Certificate (last attended)/ Bonafide certificate of the college w here admission has already been taken.
(ii) The candidate admitted in last academic year in any Agricultural University in Maharashtra if again applies to seek the admission for the
current academic year for the first year degree course, then the Bonafide Certificate issued from the last attended respective College/Institute
w ill be considered.
Caste Certificate issued by competent Authority designated in the State.
Caste Validity certificate issued by competent Authority designated in the State for SC / ST /VJa / NTb / NTc / NTd / OBC / SBC categories.
Non Creamy Layer Certificate issued by competent Authority for VJa / NTb / NTc / NTd / OBC / SBC categories Avalid up to 31 March 2021.
Certificate of Tahsildar for Economically Weaker Section in open category
(A) Whether the "Certificate of the Freedom Fighter" issued in favour of parents / Grand parents of the Candidate is issued under the
signature of the Hon. Prime Minister / Chief Minister, Maharashtra State.
(B) If yes, w hether an Affidavit of the Freedom Fighter and if the Freedom Fighter is not alive then his/her w ife/husband/Nominee on the Stamp
Paper of Rs.100/- has been enclosed?
(C) If yes, w hether the follow ing points have been mentioned in it ?
(1) The candidate is son/daughter of the Freedom Fighter or son/daughter of son/daughter of the Freedom Fighter.
(2) The Freedom Fighter has not used this concession for any relative here before.
(3) The Freedom Fighter shall not use the concession for any relative hereafter, if the benefit is availed at this time.
"Certificate of Defense Personnel (DP)" issued by the Zilla Sainik Welfare Officer/Discharge Certificate issued by the Officer Commanding the
Regiment or Serviceman Certificate issued by the Competent Authority.
"Certificate of Physically Handicapped (PH)" issued by District Civil Surgeon or equivalent Government hospital/ Medical board.
[The percentage of disability shall not be less than 40% in case of candidate seeking reservation for physically handicapped category.]
"Certificate of Project Affected Person (PAP)" issued by District Resettlement Officer OR the competent officer, empowered (with letter of
competent officer if empowered) of Government of Maharashtra in the prescribed form that his/her parents‟/grand parents‟ land has been acquired
by the Government for Agricultural University/ Irrigation/ Power/ Defence Project having the name of beneficiary.
„Certificate of Agriculturist (AG)‟ for the year 2019-20 or 2020-21 issued by the Tahsildar/ Naib Tahsildar OR issue in the format available with
Tahasildar / Naib Tahasildar showing that the applicant or his/her parents or grand parents (Paternal) is/ are owner or tenant, holds agricultural
land and whose main source of income is derived from personal cultivation of land.

(i) Village form 7/12 extract / Khasara for the year 2019-2020 or 2020-2021 issued by the Talathi / Patwari showing that the land is in his/her
name or in the name of parents/ grand parents.
Village form 7/12 extract / Khasara for the year :
(ii) In case parents are not alive, the 7/12 extract should be in the name of family head and the candidate should attach an Affidavit of family head
on Stamp Paper of Rs.100/- (Hundred only) of the agricultural land holder stating that the applicant has legitimate share in the agricultural land.
(iii) In case the extract is not in Marathi/Hindi or English, a certified translation should be attached.
(iv) Affidavit submitted by the mother of the Candidate of her father on stamp paper of Rs.100/- (Hundred only)stating ancestral land in her name
alongwith 7/12 extract thereof.

‘Certificate of Landless Agricultural Labour’ issued by the Tahsildar/ Naib Tahsildar stating that the principal means of livelihood of the parent is
manual labour on agricultural land. (This certificate should not be in the name of applicant.) However, “Agriculturist” (AG) category will not be given
to Landless Agricultural Labour.
"Certificate of Fisherman" issued by Assistant Commissioner of Fisheries stating that the source of income is from fishing only.
NCC B or C Certificate ( Air/ Naval/ Army wing) issued by the Commandant (Passed during XI or XII Standard).
Certificate of participation in Sports/ Games issued by the District Sports Officer that the applicant has participated the College at XI and / or XII
Std. / Agriculture Polytechnic in International, National, State, District competition.
‘NSS Certificate’ issued by the competent authority in respect of Jr. College or Student’s Welfare Officer or Programme coordinator for admission
to under graduate courses.
Employers Certificate being son/daughter of Agricultural University/MCAER employee.
Certificate of Debate / Essay/ Elocution issued by the District Sports Officer that the applicant has represented the Institute at XIth and / or XIIth
Std./Agriculture Polytechnic in District, State, National, International level tournaments.
Mark sheet/Certificate of Diploma in Agriculture Science of Rural Institute Amaravti or Wardha.
Mark Sheet / Certificate’ of Diploma in Agricultural Technical School.
"Migrant/ Displaced Students from Jammu and Kashmir State" should submit Certificate from the competent authority as mentioned in Government Resolution No.
AGU-2095/23106/CR-181/19-A, dated 5/9/1996. Affidavit regarding displacement will not be entertained.
‘No objection Certificate’ from employer if employed .
Undertaking in Appendix 'G' regarding cleanliness habits
Self-Declaration letter in the prescribed format (Appendix 'E') confirming the authenticity of the uploaded original copies.
As per Government Resolution Women and Child Development Department No. Amuja2011/Pra.kra.212/ka-3, dated 02/04/2018 the certificate of orphan child issued
by Commissioner, Women and Child Development, Pune on their letter head.
Self-Declaration letter in the prescribed format (Appendix 'D') for Minority quota of Minority Religious/ Linguistic.
‘Mark Sheet / Certificate’ of Diploma in Agricultural Engineering from Jammu and Kashmir state.
Form Printed on : 11/14/2021 1:46:33 PM 3 Out Of 5 Form Printed IP Address : 106.195.15.68
College Options Details Final Print Form Application Form No AGRIUG21000919

Note : Example to read [Preference No1]-(College Code 1) | [Preference No2]-(College Code 2)

[1]-(11301) | [2]-(11101) | [3]-(11104) | [4]-(11105) | [5]-(11109) | [6]-(11111) | [7]-(11102) | [8]-(11133) | [9]-(11114) |

Declaration
I hereby declare that all the information furnished by me in this Application Form is true and complete to the best of my
knowledge and belief. I understand that entries made by me in this Application Form are final and binding on me. I
further declare that in the UG Admission Process if any information being found false or incorrect I shall be liable for
action taken by MCAER.

Place : DEULGAON RAJA

Signature of Candidate
Date : 11/14/2021 1:45:05 PM (RUSHIKESH PAYGHAN)
Print Date : 11/14/2021 1:46:33 PM

Payment Details
Application Date : 14/11/2021 Payment Type : Online

Amount : Rs. 0/- Transaction ID :

Date : 14/11/2021

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 Appendix E
‘Self-Declaration related to uploaded Original documents’

I RUSHIKESH PRALHAD PAYGHAN Son / Daughter of PRALHAD NAMDEV PAYGHAN aged

................................., Occupation ................................................................. resident of MAHARASHTRA with
Aadhar Card No. (If Available).............................................. hereby declare that the originals of documents
uploaded on website are factual. I fully understand the consequences of giving false information. If the
information is found to be false, I shall be liable for prosecution and punishment under Indian Penal Code and /
or any other law applicable thereto.

Place : DEULGAON RAJA Applicant’s Signature :

Date : 14/11/2021 Applicant’s Name : RUSHIKESH PRALHAD PAYGHAN

Form Printed on : 11/14/2021 1:46:33 PM Form Printed IP Address : 106.195.15.68

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