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    Mumbai University

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    Princy Tiwari
    This document is an application form for Saurabh Kushahar Pandey to apply for a Bachelor of Science in Information Technology (B.Sc. IT) program at Birla College of Arts, Science and Commerce. It contains personal details like name, date of birth, address, contact information, educational qualifications including marks scored in Class 10 and 12, medium of instruction, guardian details and declaration of the applicant. The applicant is seeking admission to the 5th semester of the B.Sc. IT program and has selected papers for semesters 5 and 6.

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    Mumbai University

    Uploaded by

    Princy Tiwari
    26 views2 pages
    This document is an application form for Saurabh Kushahar Pandey to apply for a Bachelor of Science in Information Technology (B.Sc. IT) program at Birla College of Arts, Science and Commerce. It contains personal details like name, date of birth, address, contact information, educational qualifications including marks scored in Class 10 and 12, medium of instruction, guardian details and declaration of the applicant. The applicant is seeking admission to the 5th semester of the B.Sc. IT program and has selected papers for semesters 5 and 6.

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    This document is an application form for Saurabh Kushahar Pandey to apply for a Bachelor of Science in Information Technology (B.Sc. IT) program at Birla College of Arts, Science and Commerce. It contains personal details like name, date of birth, address, contact information, educational qualifications including marks scored in Class 10 and 12, medium of instruction, guardian details and declaration of the applicant. The applicant is seeking admission to the 5th semester of the B.Sc. IT program and has selected papers for semesters 5 and 6.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    26 views2 pages

    Mumbai University

    Uploaded by

    Princy Tiwari
    This document is an application form for Saurabh Kushahar Pandey to apply for a Bachelor of Science in Information Technology (B.Sc. IT) program at Birla College of Arts, Science and Commerce. It contains personal details like name, date of birth, address, contact information, educational qualifications including marks scored in Class 10 and 12, medium of instruction, guardian details and declaration of the applicant. The applicant is seeking admission to the 5th semester of the B.Sc. IT program and has selected papers for semesters 5 and 6.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    For Office Use

    Batch: Scrutiny Payment: Online/DD PI

    Only Serial:

    Birla College of Arts, Science and Commerce (23)


    Application No :
    University of Mumbai
    M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
    2972233
    Academic Year: 2022-2023 Regular
    APPLICATION FORM

    Course Applied for : B.Sc. (I.T.) (Autonomous)(with Credits) - Regular - CBCS - T.Y.B.Sc. (I.T.) PRN:2020016400391082
    (Autonomous) Sem V (-)

    Application Date : 11/05/2023


    1.Personal Information
    Candidate's Name(Regional) :
    PANDEY SAURABH KUSHAHAR
    Candidate's Name as printed on
    [*This name will appear on all University
    Mark sheet :
    records/documents]
    KUSHAHAR DEEPMALA
    Father's/Husband's Name : Mother's Name :
    PANDEY PANDEY
    Marital Status : UnMarried Mother Tongue :
    Place Of Birth : Azamgarh Gender : Male Date of Birth (DD/MM/YYYY) : 15/04/2002
    Blood Group : Religion : Country of Citizenship : India
    Is Student NRI/ Foreign National : No Domicile State: Maharashtra
    Address For Correspondence :
    Location Area : Not
    State : Maharashtra District : Thane Tehsil : Kalyan City/Town/Village :
    Available
    Address (House
    Room No 1 Om Sai Ram Chawl Amardeep Colony Haji Malang Road Pisavli
    no,street/area/suburb Pin Code : 421306
    Kalyan
    etc.) :
    Contact details
    Mobile
    918369360961 Email ID: [email protected]
    Number
    2.Legal Reservation Information
    Category Type :
    Category : GEN
    Open
    Is Guardian from EBC (Economic
    Is Specially Abled? No
    Backward Class)? No
    3.Social Information(Additional Inforamtion)
    Not Applicable
    Paper Selected for:
    Sem V
    BSCIT001 - PAPER I BSCIT002 - PAPER II
    BSCIT003 - PAPER III BSCIT004 - PAPER IV
    Sem VI

    BSCIT005 - PAPER V BSCIT006 - PAPER VI


    BSCIT007 - PAPER VII BSCIT008 - PAPER VIII

    Medium of Instruction : English


    4.Guardian Information
    Occupation of Guardian : Service Annual Income of Guardian : 156000
    5.Educational Details
    Month and Exam
    Name of Name of Board/University Name of Certificate Mark Out
    Year of Seat CGPA %
    Examination and State of University School/College No. Obtained of
    Passing No.
    MAHARASHTRA STATE
    BOARD OF SECONDARY
    Std 10th March 2018 -- -- 396.00 500.00 -- - -- 79.20
    AND HIGHER SECONDARY
    EDUCATION,
    MAHARASHTRA STATE
    Std 12th 12Th BOARD OF SECONDARY February
    -- -- 406.00 650.00 -- - -- 62.46
    (Science) AND HIGHER SECONDARY 2020
    EDUCATION,
    Your Last Qualifying Exam:
    7.Other Information
    Would you like to apply for Hostel accommodation required NA
    DECLARATION
    I hereby declare that all the information furnished by me in this application form is true, complete and correct to the best of my
    knowledge and belief. I do understand that I need to obtain and produce all the required documents. I admit to having
    understood what constitutes ragging and sexual harassment. I have read the guidelines related to the same. I hereby affirm that if
    found guilty of ragging or sexual harassment I am liable for punishment according to the university regulations.

    Place : Date :
    ( Signature of the Candidate )
    Document printed on Thu May 11 2023 14:09:02 GMT+0530 (India Standard Time)

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