Maharshi Dayanand Education Society Form

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Junior College (Junior) Academic Year ( 2023 ) Subject: Form / Appl No :25237

Maharshi Dayanand Education Society's


MAHARSHI DAYANAND COLLEGE OF ARTS, SCIENCE &
COMMERCE
Shri Mangaldas Verma Chowk, 25 Dr. S. S. Rao Road, Patel, Mumbai-400012
ESTD. 1962 NAAC Re-Acccrdited "A" Grade
PROVISIONAL ADMISSION / REGISTRATION FORM

Mali Vishal Nency


Course / Class Roll No. Div. G.R. NO.
Arts / XI-FYJC-ARTS
Fees Paid Receipt No. Receipt Date Enrol. / PRN No.

PERSONAL INFORMATION
Name as per Mark Sheet (SSC or HSC): mali vishal nency Gender: MALE
Name in Devnagri: माली विशाल नैन्सी Nationality: indian
Place of Birth:
CHITROD ,RAPAR
Date of Birth: 2006-09-13 Religion: Hindu
DISTRICT -KUTCH ,
GUJURAT
Caste Category: General /
Caste: GUJURATI Mothe Tongue: Gujurati
Open
Other Reservation: None Marital Status: UN MARRIED
Address for Correspondence: 00 NO
113/1 shivam building Divyang:
b.m marg HANDICAPPED
mumbai, maharashtra - 400013 Blood Group: A+
Student's Contact No.: 9819925773
Parent's/Guardian's
9819748143
Contact No:
Email Id: Adhar Card No.:
[email protected] 379338002213
PARENT / GUARDIAN INFORMATION
Name: nency mali Relation with Student: father
Occupation: Business man Annual Income: 150000

SUBJECTS OFFERED AT 10TH EXAM with MARKS (AS per X Marksheet):


MONTH
EXAM CLASS /
COLLEGE BOARD / & YEAR TOTAL OUT PERCENTAGE NO. OF
CLASS STREAM SEAT GRADE
TYPE UNIVERSITY OF MARKS OF / SGPA ATTEMPT
NO OBTAINING
PASSING
JR SSC NA a217083 ssc
DETAILS FOR REIMBURSEMENT OF FEES TO STUDENTS
BANK NAME & BRANCH DETAILS:
ACCOUNT NO. OF STUDENT / PARENT: IFSC CODE:
ACCOUNT HOLDER: OTHER PARENT MICR CODE:
ATTACHED DOCUMENTS:
SSC MARKSHEET, 10TH LEAVING CERTIFICATE, 11TH CENTRALIZED ONLINE ADMISSION FORM, ADHAR
CARD,
I, the undersigned Mr./ Ms. Vishal Mali Nency, hereby declare that, I have read the rules related to admission and the
information filled in by me in this form is accurate and true to the best of my knowledge. I will be responsible for any
discrepancy in the form signed by me and that if I do not submit required documents in stipulated time my admission will
stand cancelled. I will abide by all the rules and regulations laid down by the College and Government. I am aware that 75%
attendance is compulsory without which I will not be permitted to appear for the examination. I herewith accept to pay full
fees, if I do not submit all the documents required for scholarship / freeship within stipulated time.

I will submit all my original documents to the college whenever required to do so. I am aware that if any information in my
admision form is found to be incorrect and if it is found that I have submitted my original document to any other college, my
Junior College (Junior) Academic Year ( 2023 ) Subject: Form / Appl No :25237

admission will be treated as cancelled.

I hereby undertake that I will submit all the required subject projects and appear for all the Practicals, Oral Examinations and
Application Based internal Tests as per HSC Board norms. If I fail to do so, the college will not be held liable for the same.

Place: mumbai - 400013

Date:

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