GOVERNMENT COLLEGE OF ENGINEERING AURANGABAD

(An Autonomous Institute of Government of Maharashtra)

Railway Station Road, Aurangabad

ELECTRICAL ELECTRONICS AND POWER ADMISSION FORM FOR YEAR - IV

Full Name of Student : AKSHAY BALAJI SIRSAT

(In Capital Letters)

Mother Name: SUREKHA BALAJI

SIRSA
Class/Semester: VII Enrollment No. : BE16F03F053

Date of Birth : 10/05/1998 Sex : MALE

Blood Group : O+
Father's / Guardian's Full Name : BALAJI

Permanet Address : (with Phone No.)

At. Ramwadi, Post. Pangaon, Tq. Renapur, Dist. Latur

Mobile No. - 9011615125

Local Address : (with Phone No.)

At. Ramwadi, Post. Pangaon, Tq. Renapur, Dist. Latur

Religion: HINDU Category : NT-D Caste : VANJARI

Name of EBC / PTC / GOVT Aadhar Card No.: 979365591688

GOI.Sch / Freeship /Ex.ser :
Email Id : akshaysirsat85@gmail.com

UNDERTAKING
a) I, the undersigned, agree to confirm to any Rule and Laws enforced by the Government and I hereby undertake that,
I will do nothing either inside or outside the Collegewhich my result in disciplinary action me under these rules.
b) I fully understand that the Principle of this College, has a right to expel me from the College for any infingement the
Rules of Conduct and discipline Prescribed by the College or University of Government.
c) I am fully aware that, I will no be allowed to apper for the College examination if I do not attend the classes of theory,
practicals, drawing etc. regularly and if fail to submit the assignments/Term work as specified by the College within the
stipulated limit.

Signature of Student

FOR OFFICE USE

1) Certificate Verified

a) Marks Demo þ b) T.C. c) Cast Validity Certificate þ

d) Defence Certificate e) EBC/PTC f) Other

Signature of Student Section Cleark

Total Payble Fees Rs.: 29,814.00

Signature of Cashier
15/08/2019 22:22:53