Application Form

Printed on Course 8/22/2013 4:29:11 PM Bachlor of Commerc in Banking Insurance GOI Post Matric Scholarship , 2013-2014 Scheduled Caste

Application Number Appilcation type Student SSC Details SSC Board Passing Year

APPE0098874M20092013 Renewal Renewal Course Year N.A

Please Paste Passport Size Photograph

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION 2009 SSC Seat No E009887 SSC Marks Obtained 66.00

Applicant's Details Applicant Name AKSHAY Date of Birth 27-05-1994 RAVINDRANAT CHAVAN H Gender Male Maritial Status No Mother's Name RANJANA

Is Resident of Maharashtra Maharashtra Caste Category Sub Caste Scheduled Caste

Application Date 22-08-2013 Caste Orphan Chambhar (11) No

Is Disabled Applicant's Annual Income

No 0.00

Disability Type

N.A.

Is Applicant Salaried ? NO Is Staying at Hostel ? No

Total Annual Income 45000.00 No

Has Applied For Hostel ?

Student Prequalifying Details

Academic Year Institute Course Course Year Percentage Result

2012 - 13

Sheth N.KT.T. College of Commerce and Sheth J.T.T. College of Arts Sheth N.KT.T. College of Commerce and Sheth J.T.T. College of Arts N.K.T.T.College.Thane.

Bachleor Of Banking Insurance 1

55.92

Pass

2011 - 12

Bachleor Of Banking Insurance 1

50.00

Pass

2010 - 11

12 th Commerce

50.00

Pass

Institution Details Name of School/College/Institute where Admitted Course Name Course Year EID Number Subject College Adm.No 35 Is Fees Paid ? Fee Receipt Date Contact Details No N.A Academic Year Admission Dt. Fee Paid GrantType 2013-2014 15-04-2013 0.00 Non Granted Is Admission after No Diploma Joining Date 16-06-2013 Fee Receipt No. Quota Government Quota Sheth N.KT.T. College of Commerce and Sheth J.T.T. College of Arts

Bachlor of Commerc in Banking Insurance 3 CAP Number N.A UID Number 497070835152

Residential Number: , MobileNumber: 8108422206, EmailAddress: akshaychavan22206@gmail.com 1 Of 2

Address For Correspondence Address:- Location:- City:- Thane Pincode:- 400601 Taluka:- Thane District:- Thane Parent / Guardian Details Parent's name RAVINDRA NATH Relation with Applicant Father Parmanent Address Is Father Alive Hostel Information Name of Landlord / Hostel Hostel Type Hostel/ Landlord Address Is Studying in night school Document Details Caste Certificate No Caste Validity Certificate No 9780 N.A District Issuing Thane Office District Issuing N.A Office Issued in 2013 Taluka Issuing Office Scrutiny Committee No University Registration No Thane N.A N.A Yes Is Mess Service Available? No Hostel Admission Date Rent Per Month Hostel/Landlord Contact Details 0.00 CHAVAN Age Profession 48(yrs) Service

Location:- Samrat Ashok nagar City:- Thane Pincode:- 400601 Taluka:- Thane District:Thane Annual Income 45000.00 Yes

Income Certificate 492/13 No Student Bank Account Details Bank Name Branch Name IFSC Code

CENTRAL BANK OF INDIA THANE CBIN0280637

Bank Account No MICR Code

3110218149

400016059

Document Attached Caste Certificate Issued by Competant Officer Income Proof Income Certificate Issued by Competant Authority Marksheets I-card Size Photo SSC Mark Sheet UID document xerox Declaration The information furnished by me is complete and correct. I bear the complete responsibility for all the above information. Applicant's Signature Principal's Signature _______________________ _______________________ Applicant Parent's Signature _______________________

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