Savitribai Phule Pune University

The Depressed Classes Mission Of India,Pune

Dr.Babashaeb Ambedkar Commerce & M.V.R Shinde Art's College

896,Ahilyashram Near Quarter Gate Nana Peth

020-26350857, Email ID : drambedkarcollege@rediffmail.com
Admission Form Details (Academic Year : 2022-2023)

Form Verification (For Office Use Only) Fill Date : 04/08/2022 07:02 PM - Print Date : 04/08/2022 07:16 PM

Sign. Sign.
Div & Subject Alot. Auth Division Roll No. Rcpt. Made By Rcpt. No. Amount Date

Sign. Sign.
Form Checked By Scholarship Verification Fee Category Caste Category Caste Member ID
INDIAN Maharashtra S.C. No
Nationality State of Resident Caste Category Is Handicapped

Registration Information

Admission Form Number : 1640984

Registration Number : 2200055267

Admission Type : Section : Class :

Provisional U.G. F.Y.BA. CBCS
Division : Fee Category : Caste Category :
NON-GRANT PAYING S.C.
Form No. (Merit/Adm.) : Uni./Board Registration No. : Eligibility No.(UG & PG) :
N.A. N.A. N.A.
CAP Application Kit No. : Adhaar Card No. : Pan Card No. :
N.A. 524252226931 PODPS4119N
Voter ID : Saral ID. :
N.A.

Student's Information

Student's Name :
SHINDE SIDDHARTH RAHUL
Father's Name : Mother's Name :
RAHUL VILAS SHINDE VAISHALI
Local Address :
Uplai Khurd
Pune Mangalwar Peth
Location : Taluka : District :
Madha Madha Solapur
State : Country : Pin Code :
Maharashtra INDIA 413209
Permanent Address :
Uplia Khurd

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N.A.
Location Type: Location : Taluka :
N.A. Madha Madha
District : State : Country :
Solapur Maharashtra INDIA
Pin Code : Email ID :
413209 siddharthshinde168@gmail.com
Mobile No. : Parent's Email :
9730074014 siddharthshinde168@gmail.com
Father's Mobile No. : Father's Profession : Father's Occupation :
9011091482 Labourer, Construction N.A.
Phone No 1 : Phone No 2 : Fax No :
9730074014 9730074014 N.A.
Gender : Birth Date : Birth Place :
Male 05/04/2004 UPLAI
Birth Place Taluka : Birth Place District : Birth Place State :
UPLAI N.A. N.A.
Birth Place Country : Delivery Place : Nationality :
N.A. N.A. INDIAN
Mother Tongue : Marital Status : Occupational Status:
Marathi Single N.A.
Blood Group : Handicap : Is Organ Donor :
B+ No N.A.
Conveyance Use : Religion : Caste :
N.A. HINDUISM MAHAR
Sub Caste : Caste Validity No.: Is Minority :
N.A. N.A. Religious
Minority Detail : Ration Card Type : Computer Course :
N.A. Orange MSCIT
Specialization: Interest : Family Doctor Name :
Arts N.A. N.A.
Family Doctor Mobile :
N.A.

Guardian's Information

Guardian's Name :
N.A.
Adress Line 1 :
N.A.
Adress Line 2 :
N.A.
Location : Taluka : District :
N.A. N.A. N.A.
State : Country : Pin Code :
N.A. N.A. N.A.
Relation With Student: Guardian's Email :
N.A. N.A.
Guardian's Mobile : Guardian's Phone : Guardian's Fax :
N.A. N.A. N.A.

Parent's Company/Occupation Information

Company Name :
N.A.
Company Email :
N.A.

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Company Web Site :
N.A.
Company Adress Line 1 :
N.A.
Company Adress Line 2 :
N.A.
Location : Taluka : District :
N.A. N.A. N.A.
State : Country : Pin Code :
N.A. N.A. 413209
Mobile No : Phone No. : Fax No. :
9011091482 N.A. N.A.
Occupational Status : Service No. : Rank :
N.A. N.A. N.A.
Present Unit : Arms : Service :
N.A. N.A. N.A.
Gall. Award : Gall. Award Details : Last Unit :
N.A. N.A. N.A.
Ward of Ward Widow : Ward of Ward Widow Details :
N.A. N.A.

Last Year's Details with (TC/LC)/Migration/Eligibility Information

Last Attended Institute Name :

KSBPV. ANGAR
Last Attended Examining Body (Board/University) :
PUNE DIVISIONAL BOARD
Last Attended Class : Last Attended College/School UDISE Code :
12TH SCIENCE 273000700209
Eligibility : State of Residence : Last Qualified Exam :
Same Institute/College M.S. 12TH HSC
Passing Month : Passing Year : Percentage :
Apr 2022 69.80
Result : Attempt : Exam Center :
A Grade 1st 0447
Seat No. : T.C./L.C. No. : T.C./L.C. Date :
P106927 66/027 31/05/2022
Migration Cert. No. : Migration Cert. Issue Date : Gap :
N.A. N.A. No

Current Year's Information

Other Activity :
N.A.
Short Term Course Offered by Inst. : Preparing for Competetive Exam :
N.A. N.A.
Availed Earn & Learn Scheme : Are From Dushkalgrast Area :
N.A. N.A.

Consession Information

Applicable Fees Consession : Bank IFSC Code : Bank Account No :

N.A. N.A. N.A.
Residence Type : Is Using Cycle Bank : Distance from College (KM) :
N.A. N.A. N.A.
Parent's Annual Income : Is Creamy Layer : No. of Family Memebrs :
N.A. N.A. N.A.

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Is BPL : Social Reservation : Consession User Name :
N.A. N.A. N.A.
Consession Password :
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.

Subject's Information

Medium : Marathi
Subject Name Subject Code Subject Group
1) EARLY INDIA : FROM PREHISTORY TO THE AGE 11171 Sub-Group - AAA1
OF MAURYA
2) EARLY INDIA : FROM POST MAURYAN AGE TO 11172 Sub-Group - AAA1
RASHTRAKUT
3) GEOGRAPHY : PHYSICAL GEOGRAPHY 110A Sub-Group - AAB1
4) HUMAN GEOGRPHY 110B Sub-Group - AAB1
5) INDIAN ECONOMIC ENVIRONMENT-I 11151 Sub-Group - AAC1
6) INDIAN ECONOMIC ENVIRONMENT-II 11152 Sub-Group - AAC1
7) INTRODUCTION TO INDIAN CONSTITUTION 11161 Sub-Group - AAD1
8) INTRODUCTION TO INDIAN CONSTITUTION II 11162 Sub-Group - AAD1
9) COMPULSORY ENGLISH 11011 Subject Group - A
10) COMPULSORY ENGLISH 11012 Subject Group - A
11) MARATHI SAHITYA : KATHA & BHASHIK 11021 Subject Group - A
KOUSHALYAVIKAS 1
12) MARATHI SAHITYA: AKANKSHA ANI BHASHIK 11022 Subject Group - A
KOUSHALYA VI
13) DEMOCRACY, ELECTION AND GOVERNENACE 12999 Subject Group - A
14) PHYSICAL EDUCATION GR1 Subject Group - A
15) VALUE EDUCATION VA_05 Subject Group - A

Previous Educational Qualification Details :

1) Institute Name : KSBPV ANGAR

Board / Uniersity Name : PUNE DIVISIONAL BOARD
Qualified Course : 12th Board (HSC) Obt. Marks : 419 Max. Marks : 600 Percentage : 69.83

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Grade : A Grade Attempt : 1st Month/Year : Apr/2022

SHINDE SIDDHARTH RAHUL SHINDE SIDDHARTH RAHUL

Scanned Signature Student's Signature

Undertaking

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.

Parent's Signature Student's Signature

Admission Admission Not

Principal's/Vice Principal's/Authority Signature Confirmed Confirmed

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 ANTI RAGGING AFFIDAVIT BY THE STUDENT
Class : F.Y.BA. CBCS -- Academic Year : 2022

Registration No. :2200055267 Date : 04/08/2022 07:16 PM

1. I, SHINDE SIDDHARTH RAHUL S/O or D/O Mr./Mrs./Ms. RAHUL VILAS SHINDE having been
admitted to The Depressed Classes Mission Of India,Pune Dr.Babashaeb Ambedkar Commerce
& M.V.R Shinde Art's College have received a copy of the UGC Regulations on Curbing the Menace of
Ragging in Higher Educational Institutions, 2009, (hereinafter called the Regulations) carefully read and fully
understood the provisions contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penal and administrative action that is liable to be taken against me in case I am found guilty for abetting
ragging, actively or passively, or being part of a conspiracy to promote ragging.
4. I hereby solemnly aver and undertake that I will not indulge in any behaviour or act that may beconstituted
as ragging under clause 3 of the Regulations.I will not participate in or abet or propagatethrough any act of
commission or omission that may be constituted as ragging under clause 3 of the Regulations.
5. I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of the
Regulations, without prejudice to any other criminal action that may be taken against me under any penallaw or
any law for the time being in force.I hereby declare that I have not been expelled or debarred fromadmission in
any institution in the country on account of being found guilty of, abetting or being part of a conspiracy to
promote, ragging; and further affirm that, in case the declaration is found to be untrue, I am aware that my
admission is liable to be canceled.

Declared on ______________________

__________________________________
Signature of Student
Name : SHINDE SIDDHARTH RAHUL
Adress : Uplai Khurd, Madha, Madha, Solapur, , Maharashtra, INDIA, 413209

Verification
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is
false and nothing has been concealed or misstated therein.

Verified at _________________________________ on _________________________________

Signature of Student

(NOTE: There is no need to get your affidavits printed on any stamp paper or get it signed by an Notary
or an oath Commissioner.)

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 AFFIDAVIT BY PARENT/GUARDIAN
Class : F.Y.BA. CBCS -- Academic Year : 2022

Registration No. :2200055267 Date : 04/08/2022 07:16 PM

1. I Mr./Mrs./Ms., RAHUL VILAS SHINDE father/mother/guardian of SHINDE SIDDHARTH RAHUL

having been admitted to The Depressed Classes Mission Of India,Pune Dr.Babashaeb Ambedkar
Commerce & M.V.R Shinde Art's College have received a copy of the UGC Regulations on Curbing the
Menace of Ragging in Higher Educational Institutions, 2009, (hereinafter called the Regulations) carefully read
and fully understood the provisions contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penaland administrative action that is liable to be taken against my ward in case he/she is found guilty of or
abetting ragging, actively or pasively, or being part of a conspiracy to promote ragging.
4. I hereby solemnly aver and undertake that My ward will not indulge in any behaviour or act that may be
constituted as ragging under clause 3 of the Regulations. My ward will not participate in or abet or propagate
through any act of commission or omission that may be constituted as ragging under clause 3 of the
Regulations.
5. I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to clause 9.1 of
the Regulations, without prejudice to any other criminal action that may be taken against my ward under any
penal law or any law for the time being in force.
6. I hereby declare that my ward has not been expelled or debarred from admission in any institution in the
country on account of being found guilty of, abetting or being part of a conspiracy to promote, ragging; and
further affirm that, in case the declaration is found to be untrue, the admission of my ward is liable to be
cancelled.
Declared on ______________________

__________________________________
Signature of Parent/Guardian
Name : RAHUL VILAS SHINDE
Adress : Uplia Khurd, Madha, Madha, Solapur, , Maharashtra, INDIA, 413209

Verification
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is
false and nothing has been concealed or misstated therein.

Verified at _________________________________ on _________________________________

Signature of Parent/Guardian

(NOTE: There is no need to get your affidavits printed on any stamp paper or get it signed by an Notary
or an oath Commissioner.)

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 SAVITRIBAI PHULE PUNE UNIVERSITY

Roll No./Admission No.

(For Office Use)

Form Fee : 50/-

APPLICATION FOR ELIGIBILITY

(For Graduate Courses Only)

I wish to apply for the Eligibility for the academic year : 2022 - 2023
1. Name of the Course to wish application is sought
B.A.(F.Y.BA. CBCS) Year:1st/2nd/3rd/4th/5th
2. Name in full of the applicant(in English Capital letters)
Name as per last Mark Sheet should be mentioned. N.R.I. student should write their names as it apperas in Passport

SHINDE SIDDHARTH RAHUL

3. Mother's Name : VAISHALI 4. Aadhar No. : 524252226931
5. Mobile No. : 9730074014 6. PAN No. : PODPS4119N
7. Email ID : siddharthshinde168@gmail.com 8. Type : Maharashtrian
9. Nationality : INDIAN 10. Religion : HINDUISM
11. Gender : MALE 12. Birth Date (DD/MM/YYYY) : 05/04/2004
13. Category (Tick mark in applicable box)
Do you belong to any of the following Reserved Categories?
If so attach a certificate of Competent Authority in support of it.
Open SC ST DT(A) NT(B) NT(C) NT(D) OBC SBC SEBC EWS

Do you belong to the creamy layer of DT(A), NT(B), NT(C), NT(D), OBC, SBC, SEBC or EWS? Yes/No
If you do not belong to the creamy layer, submit a certificate of a Competent Authority in support of it.

14. Are you a physically handicapped? No

15. Particulars of Qualifying Examination
1. Name of the Course : 12TH HSC
2. Duration of Course : ___________________________________
3. Name of the University : PUNE DIVISIONAL BOARD
4. Name of the College/Institute/University Dept. : KSBPV. ANGAR
Seat No Month & Year of Passing Percentag Class/Grade
P106927 Apr/2022 69.80 A Grade

Please specify Educational Gap Details if any

Name of Examination Seat No. Month & Year of Percentag Class/Grade

16. Are you belong to the minority ? yes / No (if yes Please specify type which has given below)
Linguistic : _____________________ Religious : ______________________

Signature of Candidate

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Copies of Following attested certificates are annexed to application form
1.Statement of Marks of the qualifying examination 2.Education Gap certificate
3.Affidavit for change in name 4.Domicile Certificate
5.Caste certificate (For reserved category candidates) 6.Cast validity certificate (For reserved category candidates)
7.Transfer Certificate 8.Migration Certificate(If applicable)/

To be filled by College / Institute / University Department

Receipt No. Date: Eligible / Not Eligible

Asst. Sr.Asst: O.S./ Registrar / HOD

* Physical Disabled Types

P1. Blind / Visually impaired/

P2. Dumb and Deaf
P3. Orthopedically impaired
P4. Mentally Challenged
OT. Other Physical Disabilities

ANNEXURE 'A' ELIGIBILITY FEE

1. Student passing qualifying examination and seeking admission First Time to First Year of any Degree / Diploma /
Certificate(U.G./ P.G.) the Eligibility Fee will be as under:

2. Admission charges for the submission of required documents will be Rs. 300 for Non-Professional courses & Rs. 500 / -
for Professional courses (Per Student) up to 30 day's from last date prescribed for submission of documents.

3. If an affiliated College admits students not eligible and who are migrating from other University / Board and allowing to
fill in Examination Form without obtaining Eligibility Certificate, a penalty of Rs.10, 000 / -per student would be imposed on
the College and the performance of Examination of such students will also be cancelled.

4. If any affiliated College admits any student not eligible for Under-graduate or Post-Graduate Courses of this University
and allows him / her to fill in the Examination Form, a penalty of Rs.5,000 / -per student shall be imposed on the College
and performance of the examination of such student shall be cancelled.

5. The same rule applies to the University Department, Centres/Schools. The Head of University department / Director of
Recognise Institute will have to pay penalty as above in case not eligible candidate is allowed to fill in the University
Examination form.

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