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Ramanand Arya D. A. V. College (169)

Station Road, Near Datar Colony. Kurla Application No :
University of Mumbai 1370845
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 - PRN:
F.Y.B.Sc. (I.T.) (Autonomous) Sem I (-)

Application Date : 12/06/2023 Payment Category :

1.Personal Information

Candidate's Name(Regional) : खान नौशाद निसार अहमद

Candidate's Name as printed on KHAN NAUSHAD NISAR AHMAD
Mark sheet : [*This name will appear on all University records/documents]
Father's/Husband's Name : NISAR Mother's Name : AMINA
Marital Status : UnMarried Mother Tongue : Hindi
Place Of Birth : Mumbai Gender : Male Date of Birth (DD/MM/YYYY) : 01/01/2006
Blood Group : Religion : Muslim Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
City/Town/Village :
State : Maharashtra District : Mumbai Suburban Tehsil : Kurla Location Area : Semiurban
Mumbai
Address (House Nisar Ahmad Khan Mohammadi Urdu High School 4,Bismillah Manzil Dargah Cross Road
Pin Code : 400078
no,street/area/suburb etc.) : Sonapur Bhandup West
Permanent Address :
City/Town/Village :
State : Maharashtra District : Mumbai Suburban Tehsil : Kurla Location Area : Semiurban
Mumbai
Nisar Ahmad Khan Mohammadi Urdu High School 4,Bismillah Manzil Dargah Cross Road
Address : Pin Code : 400078
Sonapur Bhandup West
Contact details
Mobile Number 9967991196 Email ID: nk369901@gmail.com
2.Legal Reservation Information
Category Type : Open Category : GEN
Is Guardian from EBC (Economic Backward
Is Specially Abled? No
Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem I
BSC IT 1.1 - Paper 1 BSC IT 1.2 - Paper 2
BSC IT 1.3 - Paper 3 BSC IT 1.4 - Paper 4
Sem II

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 : Service Annual Income of Guardian : 0
5.Educational Details
Month
Name of Name of Board/University and Exam Certificate Mark
Name of School/College and Year Out of CGPA %
Examination State of University Seat No. No. Obtained
of Passing
Std 10th MAHARASHTRA STATE H.K.GIDWANI March A359042 s214375240 349.00 500.00 -- - -- 69.80
BOARD OF SECONDARY AND COMOPOLITAN 2021

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Month
Name of Name of Board/University and Exam Certificate Mark
Name of School/College and Year Out of CGPA %
Examination State of University Seat No. No. Obtained
of Passing
HIGHER SECONDARY ENGLISH HIGH
EDUCATION,Maharashtra SCHOOL
NATIONAL
MAHARASHTRA STATE
EDUCATION SOCIETY
Std 12th BOARD OF SECONDARY AND February
JUNIOR COLLEGE OF M104915 h1234337859 342.00 600.00 -- - -- 57.00
Science HIGHER SECONDARY 2023
ARTS SCIENCE AND
EDUCATION,Maharashtra
COMMERCE
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.

Passing Certificate of Std 10th.

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 :1370845 (KHAN NAUSHAD NISAR AHMAD) 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 Mon Jun 12 2023 12:19:19 GMT+0530 (India Standard Time)

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