Session 2019-2020

BHAVAN'S COLLEGE College Code

:BCM

Munshi Nagar,Andheri (West), Mumbai - 400058

For College Course Applied For : M.SC PHYSICS - 1 Registration No.

use only 437459

Admission Date :

01. Personal Information Section

LAST NAME FIRST NAME MIDDLE NAME

Name of the Student PADMUKHI PRADEEP GIRIDHAR

Father's Name PADMUKHI GIRIDHAR

Mother's Name : VITHABAI In-House Student : Yes

Marital Status : UnMarried Saral No. :

Date of Birth : 19/10/1994 Gender : Male

Place of Birth : GOGI Blood Group : AB+

Grandfather Name : Native Place : Gogi

Voter ID Card No. : Organ Donor : NO

Bank Name : Account No. : Transaction Type : ONLINE

Religion : HINDU Nationality Indian UDISE No. :

Aadhar Card No. : 563182226484 Driving Licence No. :

University Pre-Registration No. :

02. Address Details

Address for Correspondence: New India welfare society, Gilbert hill road, Andheri west, Mumbai
Pin Code : 400058

State : MAHARAHSTRA District : MUMBAI Tehsil : City : ANDHERI

New India welfare society, Gilbert hill road, Andheri west, Mumbai
Permanent Address Pin Code : 400058

State : MAHARAHSTRA District : MUMBAI Tehsil : City : ANDHERI

03. Contact Details

Student Phone : Parent Phone :

Student Mobile No.: 8356881415 Student Email Id: ppadmukhi28@gmail.com

04. Legal Reservation Information Section

Domicile State : Admission Category : Caste Category : OPEN

Caste : Phy. Handicapped : NO

Caste Certificate No. : Learning Disability No. :

05. Social Reservation (Special Category) Information Section

SR NO. SOCIAL RESERVATION NAME

06. Education Details Section

Name of Name of School Date of Examination Passing Grade / Obt CGPA
Name of
Board / College Passing Seat No. Certificate No. Total Marks %
Examination
Marks

07. Qualifying Exam Details Section

Qualifying Exam Name : TYBSC
College/School Board/ Admission Passing Marks Total Percentage Place Arts/Com Education
Attended University Year Year Obt Marks /Sci Gap

Bhavans college University of 2013 2016 546 800 68.25 Mumbai Science YES
Mumbai

Qualifying Exam Subject Details

Sr.No. Subject Name Total Marks Obtained Marks

1

08. Subject Details Section

Sr.No. Subject Name Subject Type

Group Name :

09. Attached Documents

Sr No. Name of Documents/Certificates

10. Guardian / Parent Information Section

Guardian's/ Parent's Name :

Occupation of the Guardian/Parent : Annual Income of the guardian/Parent : 120,000.00

Relationship of Guardian with applicant : -- Guardian/Parent Phone No. :

11. Other Information Section

Mother Tongue : MARATHI Employment Status : NO Do you wish to join NCC / NSS: NO

Would you like to apply for Hostel : NO

Hobbies, Proficiency and Other interests : NA

Games and sports participation :

Personal Identification Marks : --

 12. Declaration by Student

I hereby declare that, I have read the rules related to admission and the information filled in by me
in this form is accurate and true to the best of my knowledge. I will be responsible for any discrepancy, arising out of the form
signed by me and I undertake that, in absence of any document the final admission will not be granted and / or admission will
stand cancel.

Place :

Date :
Signature of the Student:

13. Declaration by Guardian / Parent

I have permitted my son / daughter / ward to join your college.The information supplied by him / her is
correct to the best of my knowledge. I have acquainted myself with the rules and fees, dues to my son / daughter / ward and see
that he / she observes.

Place :

Date :
Signature of the Guardian/Parent:
14. For College / Institute Use Only
Designation Remarks / Particulars /Recommendations Signature and Date

Admission Clerk
Admission Committee
Accountant / cashier

Registrar/Office Cash Received : Rs 100.00

superintendent

REMARK OF THE ADMISSION COMMITTEE

May be admitted to Class_____________________________________________________ Section__________________

May be Rejected____________________________________________________________________________________

Last date of payment of fees __________________________________________________________________________

Admission may be cancelled if the fees are not paid by this date.

Principal Signature of Admission Committee

ACKNOWLEDGMENT Registration No. :437,459

BHAVAN'S COLLEGE
Munshi Nagar,Andheri (West), Mumbai - 400058

Received Data-Sheet for admission to M.SC PHYSICS - 1 class for Academic Year 2019-2020 of

MR. PRADEEP GIRIDHAR PADMUKHI

Receiver's Name Date Signature