Вы находитесь на странице: 1из 3

Session 2020-2021

SHRI SHIVAJI EDUCATION SOCIETY,AMRAVATI'S College Code


SCIENCE COLLEGE :SSCN

Congress Nagar, Nagpur - 440012 (M.S.) INDIA

ph. : (0712) 2423432


Website : www.sscnagpur.edu.in

For College Course Applied For : B.SC. SEM 1 Registration No.

use only 584870


Admission Date :

01. Personal Information Section RTMNU ARN NUMBER : 2021000020871

LAST NAME FIRST NAME MIDDLE NAME

Name of the Student GIRHE AKSHDA ARUN

Father's Name

Mother's Name : MADHURI In-House Student : No

Marital Status : Saral No. :


Date of Birth : 04/06/2002 Gender : Female

Place of Birth : Blood Group :

Grandfather Name : Native Place :

Voter ID Card No. : Organ Donor : NO

Bank Name : Account No. : Transaction Type : ONLINE

Religion : Nationality Indian UDISE No. :

Aadhar Card No. : 711257738184 Driving Licence No. :

02. Address Details

Address for Correspondence: PETROL PUMP MAGE,WARD NO 3 KANDRI KANHAN


Pin Code : 441401

State : MAHARASHTRA District : NAGPUR Tehsil : PARSHIVANI City : KANHAN


PETROL PUMP MAGE,WARD NO 3 KANDRI KANHAN
Permanent Address Pin Code : 441401

State : MAHARASHTRA District : NAGPUR Tehsil : PARSHIVANI City : KANHAN

03. Contact Details

Student Phone : Parent Phone :

Student Mobile No.: 9420885454 Student Email Id: akshdag81@gmail.com

04. Legal Reservation Information Section

Domicile State : Admission Category : Caste Category : OBC


Caste : Phy. Handicapped :
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

HSC STATE BOARD SHRI SHIVAJI 650 465 71.54 0.00


SCIENCE
COLLEGE
NAGPUR

SSC STATE BOARD BKCP SCHOOL 500 462 92.40 0.00


KANHAN

07. Qualifying Exam Details Section


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

SHRI SHIVAJI SCIENCE STATE BOARD 0 2020 465 650 71.54 SCIENC NO
COLLEGE NAGPUR E

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 :

07. Attached Documents

Sr No. Name of Documents/Certificates Original/Attested Attached


True Copy (Yes/No)

1. Passing Certificate of Std. 10th Attested True Copy

2. Passing Certificate of Std. 12th / Statement of Marks of Std. 12th Attested True Copy

3. Leaving Certificate Attested True Copy

4. Certificate of Caste with Category(for Caste Concession Only) Attested True Copy

5. Non Creamy Layer Certificate Attested True Copy

6. Affidavit for changed name/Marriage Certificate/ Govt. Gazette

7. Domicile Certificate Attested True Copy

8. Certificate of Physically Challenged Attested True Copy

9. Migration Certificate Attested True Copy

10. Eligibility Certificate for RTMNU Attested True Copy

11. RTMNU ARN NO DOCUMENT Attested True Copy


10. Guardian / Parent Information Section
Guardian's/ Parent's Name :

Occupation of the Guardian/Parent : Annual Income of the guardian/Parent :

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

11. Other Information Section


Mother Tongue : 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

Reg. No. 584,870 ENTER RTMNU ARN NUMBER.(ADMISSION REG. NO) : 2021000020871

Student Name AKSHDAARUNGIRHE

May be admitted to Class_____________________________________________________ Section__________________

Last date of payment of fees __________________________________________________________________________

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

Principal Signature of Admission Committee

Оценить