6/30/2017 SRTMUN

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Swami Ramanand Teerth Marathwada University,Nanded.

Application for Registration of Graduate

For Office Use Reg.No. : 7270

Batch No: Serial No:

Applicant
New
Type:
Registered
Graduate N/A
No:
Name PATIL Mahesh ganpatrao
(Last Name First Name Middle name)

Date Of
1995-05-01
Birth:
Mobile
9585652585
No.:
Email : mgpatil@gmail.com

Current at post nanaded

Address:

District: Nanded

Taluka: Nanded

College
YESWAN MAHAVIDHYALAY NANDED
Name:
Faculty: commerc

Degree: B.Com

Note: voting centre will be allocated as pe the order of preference, taking into consideration the availability of the voting Centre.

Preferred Voting Centre

Yeshwant Mahavidyalaya, Nanded

K. R. M. Mahila Mahavidyalaya, Nanded

Netaji Subhashchandra Bose Mahavidyalaya, Nanded

Enclosures :

1) Degree Certificate
2) Proof of Residence(Any one from the following)

Aadhar Card Voting Card

Ration Card Passport

Light Bill Driving License

Registeration fee (non-refundable) details:
NEFT UTR No/UNIVERSITY CASH COUNTER Receipt No Date Amount

15.00
Declaration
I request that my name may kindly be registered as Registered Graduate of the Swami Ramanand Teerth Marathwada University, Nanded. I declare that, I, -
(A) am not of unsound mind and do not stand so declared by a competent court;
(B) am not an undischarged insolvent;
(C) have not been convicted for an offence involving moral turpitude;
(D) have not obtained a degree by fraudulent means; and
(E) am not a registered graduate of any other University established by law in the State of Maharashtra.

I declare that the information furnished in the form is true and correct to the best of my knowledge and belief. In case
any information given by me is found to be incorrect or false, my application shall be liable to be rejected.

Signature of Applicant
Date:
Place:

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