1. Information about Candidate:

1. Full Name(Surname Firstname Middlename)

2. Student Email Id

3. Contact number

4. Date of Birth

5. Nationality

6. Aadhar Card No.

7. Mother Name

8. Blood group

9. Whether Physically Challenged?
YesNo

10. Gender
MaleFemale

11. Marital Status
UnmarriedMarried

12. Religion
—Please choose an option—HinduMuslimJainOther

13. Cast Category
—Please choose an option—OpenOBCSCSTNT-ANT-BNT-CNT-DVJSBCMinority

14. Cast

15. Eligibility No:

16. Scholarship:
—Please choose an option—E.B.Cother

17. Bank Account no:

18. Local Address:

19. Permanent Address:

2. Information About Parent:
1. Parent Name:

2. Parent Contact:

3. WhatsApp no:

4. Occupation:

5. Aadhar no:

6. Relation :

7. Parent Email:

8. Annual income Rs:

9. Annual income (in words) Rs:

3. Last college attended:
1. college name:

2. Class:

3. Year :

4. Marks:

4. Examination Passed:
1. Details of SSC(10th)
Name of Examination:

College/School

University/Board

Seat No.

Passing Month & Year

Percentage

2. Details of HSC(12th)
Name of Examination:

College/School

University/Board

Seat No.

Passing Month & Year

Percentage

3. Selected Subjects:
Choose your Stream:
—Please choose an option—ScienceArts

6. I hereby attach following documents with this form:
1. Original Leaving Certificate.2. Original Marksheet of12th.3. Attested xerox copy of Leaving Certificate4. Attested xerox copy of 12th Marksheet5. 3 Passport size photographs.6. Attested xerox copy of Cast Certificate7. Xerox income certificate of Tahasil8. Attested xerox copy of validity certificate.9. Bank passbook Front page xerox (one)10. Aadharcard xerox (one)11. Election card xerox (one)

I have read all the rules and regulations in force in the college and hereby agree to confirm to them and to such other rules as may hereafter be made by the Government and the college and accept the decision of the Principal in the matter pertaining to the college as final.
I hereby submit to the disciplinary jurisdiction of the vice-chancellor and authorities of the Savitribai Phule Pune University and the authorities of the college and shall observe and abide by the rules made by the vice-chancellor in that behalf and also by the rules made by the Principal of the college.
I certify that the information given above is true to the best of my knowledge and belief.
Yours Obediently

Note: PDF of this form will be sent to above submitted student email id for taking printout.

1. Printout of this form must be submitted in college along with all the documents mentioned above.

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