Sracent 1: T60To0aT Ter Teaching Sa Rare Fooa Pais TATE SHRI VISHNU WAMAN THAKUR CHARITABLE TRUSTS Bhaskar Waman Thakur College of Science, ‘Yashvant Keshav Patil College of Commerce, Vidya Dayanand Patil College of Arts, (ated to University of Mumbai) (NAAC ACCREDITED: Grade, CGPA 2.63) ‘Ya Colage Road VeaiWest P40 1309 TotN02502615276178 ‘ADMISSION FORM FOR SYBMM(ENG) 2017-2018 Student ID: 16070047 Full Name: Address: Mobile No: Email 0: Birth Place: Category: Nationality Religion: Married/Unmarried: ‘Aadhar No: Father Occupation: Business/Service Address: Mother Occupatio Business/Service Address: PAUL CATHERINE JOHN ESTHER FLAT NO:-04, MATOSHREE APT SHANKESHWAR NAGAR, ACHOIV NAGAR ACHOLE ROAD THANE 401209 ‘aogo4s0408, Phone No: 9967826579 Johncatherinepaul@gmail.com Date of Birth: December 20, 1998 HUBLI Bloodgroup: Btve OPEN Caste: NULL Domicile: CHRISTIAN Gender: Female Unmarried Physically Challanged: - E Voter 10: FE SERVICE Tel No: 9987078767 Panchmahal transport Co. 99/101, Keshayji Naik Road, Shop No. 8-9, Mahajan Wadi, Chinch Bunder, Next to Vijay Transport, Dongri, Mumbai- 400 009 HOUSE WIFE Tel No: 9773753411 FLAT NO-04, C:WING, MATOSHREE APT SHANKESHWAR NAGAR, ACHOIV NAGAR ACHOLE ROAD THANE 401209 No.of Persons in 5 ‘Annual income of the. 102000 Family: family: Earning: 1 Non-Earning: 4 Have You Applied for No Whether a Member of No ‘ScholarshipiFr NCCINSS: Proficiency acquired in Extra curricular Activities: — ‘SEMICE: 18 SEM II CE: 18 SEM Ill CE: ~ ‘SEM IV CE: - Declaration by Student hereby declare that, | hav fas he mee estec 1 w@mesin and he ifornton fled by me itl fom accurate ard uve to the bast, cof my knomlesge. |i be responsible for any dcepency, aang out fe on sina by me and I undarake that, wthout ecassary document he tal Note In cas of nackward cass, FreeshiiScholarchle subject to sanction by Gov. They winot be alowed change of seam. ‘Student's Signature Name of Applicant: ‘Admission Couse: ‘Academic Year: Parent's Signature LATE SHRI VISHNU WAMAN THAKUR CHARITABLE TRUST'S. Viva College Virar(W) PAUL CATHERINE JOHN ESTHER ‘SYBMM(ENG) 2017-2018 Student ID: 16070047 Form Fees: = 1001-