1. Information about Candidate:

1. Full Name(Surname Firstname Middlename)

2. Mother Name

3. Gender
MaleFemale

4. Marital Status
UnmarriedMarried

5. Nationality

6. Date of Birth

7. Religion
—Please choose an option—HinduMuslimJainOther

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

9. Cast

10. Eligibility No:

11. Aadhar Card No.

12. Bank Details: Bank Name

13. Bank Details: Branch Name:

14. Bank Account no:

15. Contact number

16. Student Email Id

17. Permanent Address:

18.Address for correspondence:

2. Information About Parent:
1. Father's Name:

2. Occupation:

3.Mobile number(preferably WhatsApp no):

4. Annual income (in Rupees):

3. Academic Information:

1. Last school/college Attended:

2. University/Board

3. Year of passing (12th/last examination) :

4. Exam Seat No.

5. Total Marks:

6. Percentage:

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

6.Documents Attached (Tick if Attached) :
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 declare that the information provided above is accurate to best of my knowledge and belife. I agree to abid by all the rules and regulations of SavitribaiPhule University and the college.

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 the Fees and all the documents mentioned above.

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