Application Form

Please Paste Pasport Size Photograph Renewal Course Year N.A

Application Number Appilcation type Student SSC Details SSC Board Passing Year Applicant's Details Applicant Name Date of Birth

APP4486111200000037 New

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION 2006 SSC Seat No F147202 SSC Marks Obtained 59.46

SONALI
first name

MANOHAR
middle name

KORE
last name

Mother's Name Is Resident of Maharashtra Application Date

MEENA Maharashtra

18-06-1991

Gender

Female

Academic Year Caste Category Caste Orphan Is Applicant Salaried ? Maritial Status

2011-2012 Scheduled Caste Chambhar (11) No No Is Disabled Sub Caste No

22-09-2011

Disability Type

N.A. 425906.00

Applicant's Annual 0.00 Income Is Staying at Hostel ? No

Total Annual Income Has Applied For Hostel ?

No

No

Student Prequalifying Details Last attended School/College/Institute Last Exam Passed Passed Institution Details Name of School/College/Institute where Admitted Course Name Subject College Admission 1170007 Number Is Fees Paid ? Fee Receipt Date No K.E. Society's Rajarambapu Institute of Technology, Management Studies (MBA),Walwa,Sangli - 415414 BCA Yes GANGABAI KHIVRAJ GHODAWAT KANAYA MAHAVIDYALAYA JAYSINGPUR Last Exam Passed Year 2011 Last Exam Marks 67

Master of Business Administration Is Admission after Diploma Date Of Admission Fee Paid Course Year No 20-07-2011 Academic Year Joining Date 2011-2012 22-08-2011

0.00 1

Fee Receipt No. Quota Government Quota

Contact Details Residential Number: N.A, MobileNumber: 9503706236, EmailAddress: koresonali13@yahoo.in

Address For Correspondence Address:- A/P : KACHARE HOU.SOC. PLOT 198 SAJAI NIWAS JAYSINGPUR TAL : SHIROL City:- JAYSINGPUR Pincode:- 416101 Taluka:- Shirol District:- Kolhapur Location:- JAYSINGPUR

Parent / Guardian Details Parent's name MANOHAR

first name

GOPAL
middle name

KORE
last name

Relation with Applicant

Father

Parent Age

46

(yrs)

Profession

Service 425906.00

Parmanent Address A/P : KACHARE HOU.SOC. PLOT 198 SAJAI NIWAS JAYSINGPUR TAL : SHIROL Hostel Information Name of Landlord / N.A Hostel Hostel Type N.A Is Mess Service Available? No

Parents Annual Income

Hostel Admission Date Rent Per Month

N.A

Hostel/ Landlord Address

N.A

Hostel/Landlord Contact Details

N.A

Is Studying in night school Document Details

No

Caste Certificate No MAG/SR/S747/06

District Issuing Office District Issuing Office

Kolhapur

Taluka Issuing Office Scrutiny Committee No

Shirol

Caste Validity Certificate No Income Certificate No University Registration No Student Bank Account Details Bank Name Branch Name ABRPK6531C

Issued in

2011

Bank Account No

Document Attached Caste Certificate Issued by Competant Officer Income Proof - Form 16 Marksheets I-card Size Photo

Declaration The information furnished by me is complete and correct. I bear the complete responsibility for all the above information.

Applicant's Signature

Applicant Parent's Signature

Principal's Signature