G. S.

MANDAL'S

Marathwada Institute of Technology

Beed Bypass Road, Aurangabad - 431010 Maharashtra, INDIA

2021 - 22
Form No.- EE Tech.-38

Personal Information
Full Name SHUBHAM SUNIL Branch EE Tech. [ First Shift ]
KHANDARE
DOB Sep 11,2003 Gender MALE
Email Id shubham.khandare@mit.as Mother's Name KARUNA
ia
State of Domicile MAHARASHTRA Applicant Registered 7020590575
Mobile Number
Alternate Contact No 7020590575 Religion BUDDHIST
Caste NAV BOUDHA Sub Caste
Mother Tongue MARATHI Admission Quota Type: CAP DSY
Reserve Category: SC Blood group AB+
Place of Birth
Adhaar Card Number 885127237657
Nationality Indian
Residence Address Details
Residence Address F-NO.705, DISHA CHAITRABAN SOCIETY, NAKSHATRAWADI
Country INDIA State MAHARASHTRA
City Pin 431001
AURANGABAD
Taluka District
Permanent Address Details
Permanent Address FLAT NO. 705, DISHA CHAITRABAN SOCIETY, NAKSHATRAWADI AURANGABAD
Country INDIA State MAHARASHTRA
City Pin 431001
AURANGABAD
Taluka District
Parent Details
Father's Full Name: Sunil Yashwant Khandare
Mother's Full Name: Karuna Sunil Khandare
Father's Email ID : sunil8012016@gmail.com Father's Mobile No. : 9322378737
Mother's Email ID : Mother's Mobile No. : 9356042089
Address : Flat No. 705, Disha Chaitraban Society, Nakshatrawadi Aurangabad Aurangabad Aurangabad Aurangabad
431001
Pin Code : 431001
Father's Profession : Private Service Mother's Profession :
Father Annual Income : 50000 Mother Annual Income :
Std.X
Total Marks Obtained / 413 / 500 Percentage ( % ) 82.6
Out of
Roll No./ Seat Number K004221 Year of Passing 2019
Board of Examination MAHARASHTRA STATE BOARD
Std.XII
Total Marks Obtained / 1306 / 1700 Percentage ( % ) 76.82
Out of
Year of Passing 2022 Stream SCIENCE
HSC roll no./ Seat No. 193029 Board of Examination Govt Poly Aurangabad
Autonomous
Documents attached
1 S.S.C. (Std. X) mark sheet.
2 College Leaving Certificate
3 Certificate of the Indian Nationality of the Candidate
4 Caste Certificate (If Applicable)
5 Caste Validity Certificate (If Applicable)
6 Aadhar Card

BEED BYPASS ROAD, AURANGABAD - 431010 MAHARASHTRA, INDIA Page 1

 G. S. MANDAL'S

Marathwada Institute of Technology

Beed Bypass Road, Aurangabad - 431010 Maharashtra, INDIA

7 Diploma Mark Sheet

Declaration to be signed by the Applicant:
DECLARATION BY THE APPLICANT

I Shubham Sunil Khandare the undersigned declare that the information filled by me in the admission form is correct to the best of my
knowledge. The information field shall be treated as final & any error in the information may lead to cancellation of my admission

Place :
Date : Aug 28, 2023 08:31 PM
Signature of Candidate

BEED BYPASS ROAD, AURANGABAD - 431010 MAHARASHTRA, INDIA Page 2