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10/27/2015

ApplicationformPrintout

[STUDENTCOPY]

ApplicationFormNumber:1279833

Arts,CommerceandScienceCollegeSindhudurg

VidyaBhavan,MumbaiGoaExpressRoad,JaitapkarColony,Oros.,Sindhudurnagari
UniversityofMumbai

B.A.(withCredits)RegularC7525F.Y.B.A.F.Y.B.A.SemI
(MediumMarathi)

ApplicationForm1279833

1.PersonalInformation
NameofApplicant:

PARABANJALIPRAMOD

Father's/Husband'sName(MiddleName):

PRAMOD

DateofBirth:

28Dec1995

Gender:

PlaceofBirth:

MALVAN

MobileNumbers:9404141317

AddressforCorrespondence:

A/PMALVANVERAL,City:MALVAN,Taluka:Malvan,District:Sindhudurg,State:Maharashtra,
Country:India,Pin:416606

ContactNumber:

NotAvailable

Female

Mother'sFirstname:

SUPRIYA

MaritalStatus:

UnMarried

EmailId:NotAvailable

SocialReservationInformationofApplicant:
2.PapersSelectedfor:F.Y.B.A.
[UBA1.3]Marathi

[UBA1.35]PaperIEconomicsTheory

[UBA1.42]PaperIMarathi

[UBA1.28]PaperIHistoryofModern
Maharashtra18481960AD

[UBA1.1]SocialAwareness,PersonalityDevelopment&
CurrentAffairsI(F.C.I)

[UBA1.2]PaperICommunication
SkillsinEnglish

3.EducationalDetailsSection
Nameof
Examination

Stream

NameofBoard/University

SchoolName

Dateof
Passing

Grade/Total
Seat Qualifying
Marks
Number
Exam
Obtained

10th

NA

MAHARASHTRASTATEBOARD NEWENGLISHSCHOOL
OFSECONDARYANDHIGHER MALVAN
SECONDARYEDUCATION

Apr2012

364/550

12th

Commerce

MAHARASHTRASTATEBOARD JR.COLLEGEMALAGOAN
OFSECONDARYANDHIGHER
SECONDARYEDUCATION

Feb2014 346/650

B031669

W026554

4.RequiredDocumentsandCertificatesSection(Pleasetickmarkthedocumentthatyouhaveattachedtothisform)
PassingCertificateofStd10th.

LeavingCertificate.

5.DeclarationbyApplicant
Iherebydeclareandagreethat,
1. ThisApplicationmostlyincludeallthemajorCoursesandCollegesoftheUniversity.However,iftheCoursesandCollegesoftheUniversityarenotlistedinthe
application,thenitismyresponsibilitytocontacttheCollegeseparatelyforapplyingfortheCoursesthatarenotlisted.
2. Iknow,UniversitymayaddaffiliationtonewCollegesoraffiliatenewCoursetoexistingCollegesaftermyapplication.ItwillbenotifiedthroughaCorrigendum
onportal.ItismyresponsibilitytocheckthesameregularlyandapplyforthenewlyaddedCourse/College,ifinterested.
3. Ihavereadtherulesrelatedtoadmissionandtheinformationfilledinbymeinthisformisaccurateandtruetothebestofmyknowledge.Iwillberesponsible
foranydiscrepancy,arisingoutoftheformsignedbymeandunderstandthat,intheabsenceofanydocument,thefinaladmissionwillnotbegrantedand/or
admissionwillstandcancelled.

IamawareoftheAntiRaggingActandIstatethatIwillabidebyalltherulesandregulationofthesaidAct.
Place:
Date:

SignatureoftheApplicant:

6.DeclarationbyParent/Guardian
Ihavepermittedmyson/daughter/wardtoapplyinyourCollege.Theinformationsuppliedbyhim/heriscorrecttothebestofmyknowledge.I
haveacquaintedmyselfwiththerulesandfees/duesrelatedtotheprogram.
Place:
Date:SignatureoftheGuardian:
7.ForCollege/InstituteUseOnly
Designation

Remarks/Particulars/Recommendations

SignatureandDate

AdmissionClerk
Admission
Committee
Accountant/Cashier CashReceived:Rs.

ReceiptNo.:

Registrar/Office
Superintendent
Note:AftersubmittingCollegeCopyofApplicationForm,pleasetaketheAcknowledgementfromthecollegeonStudentCopyofApplicationForm.

http://mumadmission.digitaluniversity.ac/OnlineAdmissions/PrintApplication.html

1/2

10/27/2015

ApplicationformPrintout

[SUBMISSIONCOPY]

ApplicationFormNumber:1279833

Arts,CommerceandScienceCollegeSindhudurg

VidyaBhavan,MumbaiGoaExpressRoad,JaitapkarColony,Oros.,Sindhudurnagari
UniversityofMumbai

B.A.(withCredits)RegularC7525F.Y.B.A.F.Y.B.A.SemI
(MediumMarathi)

ApplicationForm1279833

1.PersonalInformation
NameofApplicant:

PARABANJALIPRAMOD

Father's/Husband'sName(MiddleName):

PRAMOD

DateofBirth:

28Dec1995

Gender:

PlaceofBirth:

MALVAN

MobileNumbers:9404141317

AddressforCorrespondence:

A/PMALVANVERAL,City:MALVAN,Taluka:Malvan,District:Sindhudurg,State:Maharashtra,
Country:India,Pin:416606

ContactNumber:

NotAvailable

Female

Mother'sFirstname:

SUPRIYA

MaritalStatus:

UnMarried

EmailId:NotAvailable

SocialReservationInformationofApplicant:
2.PapersSelectedfor:F.Y.B.A.
[UBA1.3]Marathi

[UBA1.35]PaperIEconomicsTheory

[UBA1.42]PaperIMarathi

[UBA1.28]PaperIHistoryofModern
Maharashtra18481960AD

[UBA1.1]SocialAwareness,PersonalityDevelopment&
CurrentAffairsI(F.C.I)

[UBA1.2]PaperICommunication
SkillsinEnglish

3.EducationalDetailsSection
Nameof
Examination

Stream

NameofBoard/University

SchoolName

Dateof
Passing

Grade/Total
Seat Qualifying
Marks
Number
Exam
Obtained

10th

NA

MAHARASHTRASTATEBOARD NEWENGLISHSCHOOL
OFSECONDARYANDHIGHER MALVAN
SECONDARYEDUCATION

Apr2012

364/550

12th

Commerce

MAHARASHTRASTATEBOARD JR.COLLEGEMALAGOAN
OFSECONDARYANDHIGHER
SECONDARYEDUCATION

Feb2014 346/650

B031669

W026554

4.RequiredDocumentsandCertificatesSection(Pleasetickmarkthedocumentthatyouhaveattachedtothisform)
PassingCertificateofStd10th.

LeavingCertificate.

5.DeclarationbyApplicant
Iherebydeclareandagreethat,
1. ThisApplicationmostlyincludeallthemajorCoursesandCollegesoftheUniversity.However,iftheCoursesandCollegesoftheUniversityarenotlistedinthe
application,thenitismyresponsibilitytocontacttheCollegeseparatelyforapplyingfortheCoursesthatarenotlisted.
2. Iknow,UniversitymayaddaffiliationtonewCollegesoraffiliatenewCoursetoexistingCollegesaftermyapplication.ItwillbenotifiedthroughaCorrigendum
onportal.ItismyresponsibilitytocheckthesameregularlyandapplyforthenewlyaddedCourse/College,ifinterested.
3. Ihavereadtherulesrelatedtoadmissionandtheinformationfilledinbymeinthisformisaccurateandtruetothebestofmyknowledge.Iwillberesponsible
foranydiscrepancy,arisingoutoftheformsignedbymeandunderstandthat,intheabsenceofanydocument,thefinaladmissionwillnotbegrantedand/or
admissionwillstandcancelled.

IamawareoftheAntiRaggingActandIstatethatIwillabidebyalltherulesandregulationofthesaidAct.
Place:
Date:

SignatureoftheApplicant:

6.DeclarationbyParent/Guardian
Ihavepermittedmyson/daughter/wardtoapplyinyourCollege.Theinformationsuppliedbyhim/heriscorrecttothebestofmyknowledge.I
haveacquaintedmyselfwiththerulesandfees/duesrelatedtotheprogram.
Place:
Date:SignatureoftheGuardian:
7.ForCollege/InstituteUseOnly
Designation

Remarks/Particulars/Recommendations

SignatureandDate

AdmissionClerk
Admission
Committee
Accountant/Cashier CashReceived:Rs.

ReceiptNo.:

Registrar/Office
Superintendent

http://mumadmission.digitaluniversity.ac/OnlineAdmissions/PrintApplication.html

2/2