Savitribai Phule Pune University

*214008158437*

Application ID: 214008158437

Course Name

Total Fees :1000

Mar/Apr 2016

[ S.E.(2014 PAT.)(CIVIL) ]

Instructions to the Candidate:

1.This Exam form along with fee amount should be submitted to the respective college .
2.Repeater students shall attach attested true copy of the last mark sheet alongwith this form.
3.This form will be considered ONLY AFTER Approval from the concern College.
To,
The Controller of Examinations, Savitribai Phule Pune University, Pune-411 007.
Madam/Sir, I request permission to present myself at the examination courses, mentioned below

1.Personal Details:
Name of the Applicant

GIRI GAJENDRA GAUTAM

Name of the Applicant's Mother

SUNDAR

Gender

MALE

Category

DT/NT

Address for Communication

Near akurdi railway station gurudwara

chowk,Pune,411044

Contact Number

8600623724

Permanent Registration Number:(PRN )

71633891C

11 digit UNIPUNE ID. (Eligibility No.)

00

Email-ID

Gajendragiri87@gmail.com

Sports Info / Extra Information

NA

Is Physically Disabled

Not Applicable

Those students who desire to claim benefit under 0.163 will have to submit their prescribed form with
requisite fees of Rs. 10/- and necessary certificates thereof through the Principal of their College before the
commencement of this examination only. Prescribed forms are available in the College Office. After the

declaration of the Result such application will not be accepted.

2. Examination Details
College Name

D.Y. PATIL COLLEGE OF ENGINEERING PUNE =(CEGP010530 )

Last Appearance
Year

Month

SeatNo

2012

Oct/Nov

S140080075

Applied Subjects Information :

TW

INSEM

TH

PR

OR

Sem

201004

Sub Code

FLUID MECHANICS I

Subject Name

201005

ARCHITECTURAL PLANNING AND DESIGN

OF BUILDING

201007

CONCRETE TECHNOLOGY

201008

STRUCTURAL ANALYSIS I

1 of 2

201009

TESTINIG OF MATERAILS

207009

ENGINEERING GEOLOGY

207001

ENGINEERING MATHEMATICS III

3. Fee Details
Fee Type

Fee Amount

Remarks

Form Fee

30

Exam Fee

720

Statement of Marks Fee

125

CAP Fee

125

Passing Certificate Fee

Project Fee

Late Fee

Fine Fee

N.S.S. Fee

Total Fee to Be Paid:

1000

DROUGHT HIT DECLARATION :

I hereby declare that the drought hit details filled by me are correct. I SHALL BE RESPONSIBLE for any
errors and wrong or incomplete entries made by me in the Examination form regarding Drought Hit details.
1) I am not getting any concession on examination fee as per the government schemes for
education.
2) My Parents are not working/business in City.
3) I have no backlogs.
4) My village comes under declared drought hit area.
[ If college will verify and approve your drought hit document then only Fee Exemption regarding
Drought Hit will applied to you. ]
Total Exam Fee Rs

: 1000

Drought Hit Fee Exemption Rs.

: 880

After Exemption

: 120

DECLARATION :
I hereby declare that I have gone through the Syllabus and the list of books prescribed for the examination
for which I am appearing. I SHALL BE RESPONSIBLE for any errors and wrong or incomplete entries made
by me in the Examination form.
I shall not request for special concession such as change in the time and/or day fixed for the University
examination etc. on religious or any other grounds.
Yours faithfully
Place : ________________ Date : ________________

Signature of the Candidate

Place : ________________ Date : ________________

Stamp & Signature of the Principal

2/24/2016 7:43:43 PM

2 of 2