DIRECTORATE OF TECHNICAL EDUCATION

3, MAHAPALIKA MARG, POST BOX NO. 1967, MUMBAI - 400 001

Application Form for Rajarshi Chhatrapati Shahu Maharaj Fee Reibmursement Scheme
for the Academic Year 2017-18
Application ID : DSE15114905 Version No : 2 MahaDBT Application No : POSDB022170000391718
Personal Details
Candidate Name BACHIPALE DNYANDEEP RANGRAO
Gender Male
DOB (DD/MM/YYYY) 15/10/1997
Candidature Type Maharashtra - Type A
Category OPEN
Mother Tongue Marathi
Religion Hindu
Region Aurangabad
MAYUR NIVAS, SAI ROAD CORNER, BHAKTI NAGAR, LATUR
Permanent Address
Taluka - Latur District - Latur State - Maharashtra PIN - 413512
Mobile No 8177810246 E-Mail ID bachipalednyandeep@gmail.com
Admission Details
Admission Year 2015
Program Type Direct Second Year Degree in Engineering-Technology
Institute Name 6272 - Dr. D. Y. Patil Pratishthan's D.Y.Patil College of Engineering Akurdi, Pune
Course Name Civil Engineering[Second Shift]
Choice Code 627219120 Seat Type CAP
Admission Date 10/08/2015 Reporting Date 10/08/2015
CAP Round 1 CAP Merit No 4686
Other Personal Details
Father's Name RANGRAO Mother's Name SANDHYA
Guardian's Name RANGRAO GUNDERAO BACHIPALE Guardian's Native Place LATUR
Candidate's Birth Place LATUR SSC Roll Number L006080
Current Studying Year Final Year PRN / Enrollment Number 71633876K
Name of School / Institute Last Attended VDF SCHOOL OF POLYTECHNIC, LATUR
Address of School / Institute Last Attended NEW MIDC,Manjara sugar meal,Latur.
Applied For Any Other Scholarship / Concessions None
Child Number 1
Aadhaar Number 782166436358 (Aadhaar Number Verified by DTE)
Candidate’s Name (As Per Aadhaar Record) BACHIPALE DNYANDEEP RANGRAO
Family Income Details (For Financial Year 2016-17)
Total Family Income (Including Both Parents) Rs . 60,000/-
Income Certificate Issuing Authority Collector
Income Certificate Number 42263083902
Income Certificate Issue Date 21/06/2017
Candidate's Bank Details
Candidate’s Name (As Per Bank Record) DNYANDEEP RANGRAO BACHIPALE
Bank Name State Bank of Hyderabad
Branch Name ARVI
Account Number 62431878610 IFSC Code SBIN0021543
MICR Code 413004991 Account Seeded with Aadhaar Yes
Qualification List (Starting from SSC till Last Exam Passed)
Passing Month & Marks
Qualification Year of Study Result Marks
Year Type
SSC SSC Distinction March, 2012 Percentage 429.00/500.00 (85.80)
Diploma Diploma Distinction June, 2015 Percentage 1369.00/1650.00 (82.97)
Direct Second Year Degree in Engineering-
Second Year First Class May, 2016 Percentage 945.00/1500.00 (63.00)
Technology
Direct Second Year Degree in Engineering-
Third Year First Class July, 2017 Percentage 966.00/1500.00 (64.40)
Technology
Exam Fee / Tution Fee Details
Odd Semester Exam Fee Rs . 880/- Even Semester Exam Fee Rs . 940/-
Tution Fee Rs . 00/- Total DBT Amount Rs . 910/-
List of Documents Required
Sr. No. Document Name
Family Income Certificate of Financial Year 2016-17 issued by Tahsildar / Sub Divisional Officer / Deputy Collector /
1.
Collector of the District / Metropolitan Magistrate.
2. Domicile Certificate of Maharashtra / Maharashtra Karnataka Border.
3. Statement of Marks of Last Year attested by the Principal. (If Applicable)
4. GAP Affidavit. (If Applicable)
5. Death Certificate of Father, If Not Alive. (If Applicable)
6. Aadhaar Card.
 7. Bank Passbook Front Page Copy / Cancelled Cheque.
8. Leaving Certificate.
9. CAP Admission Allotment Letter.
Declaration
The above information given by me for Rajarshi Chhatrapati Shahu Maharaj Fee Reibmursement Scheme as a parent is true to the
best of my knowledge & belief. If at later stage, it is found that I have furnished wrong information and /or submitted false certificates, I
am aware that my sons/daughters admission stands cancelled.
I am aware that if my family income is found above the limit fixed by the Authority, I will have to pay two fold of amount
sanctioned by the Authority. The authority may recover the amount from me, from my heritor or as dues on land revenue in case of not
returning the amount.

Place : Date :

Printed On : 23/2/2018 12:50:25 PM Father/Mothers/Guardian Signature Candidate Signature

Last Modified On : 23/2/2018 12:50:18 PM (BACHIPALE DNYANDEEP RANGRAO)