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    syed nazira
    Sahil Shaikh Faizan has applied for admission to the B. Pharm program at Anjuman-I-Islam Kalsekar Technical Campus School of Pharmacy. He is a 22 year old Muslim male from Mumbai, India. He has completed his 10th standard from Chembur Station Municipal Urdu Secondary School in 2019 with 83% and his 12th standard (Science) from NG Acharya and DK Marathe College of Arts Science and Commerce in 2021 with 85.67%. He is seeking regular admission to the first semester of the B. Pharm program and has selected the relevant course papers. His father's occupation is listed as a laborer and their annual family income is 96,

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    Sahil Shaikh Faizan has applied for admission to the B. Pharm program at Anjuman-I-Islam Kalsekar Technical Campus School of Pharmacy. He is a 22 year old Muslim male from Mumbai, India. He has completed his 10th standard from Chembur Station Municipal Urdu Secondary School in 2019 with 83% and his 12th standard (Science) from NG Acharya and DK Marathe College of Arts Science and Commerce in 2021 with 85.67%. He is seeking regular admission to the first semester of the B. Pharm program and has selected the relevant course papers. His father's occupation is listed as a laborer and their annual family income is 96,

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    Sahil Shaikh Faizan has applied for admission to the B. Pharm program at Anjuman-I-Islam Kalsekar Technical Campus School of Pharmacy. He is a 22 year old Muslim male from Mumbai, India. He has completed his 10th standard from Chembur Station Municipal Urdu Secondary School in 2019 with 83% and his 12th standard (Science) from NG Acharya and DK Marathe College of Arts Science and Commerce in 2021 with 85.67%. He is seeking regular admission to the first semester of the B. Pharm program and has selected the relevant course papers. His father's occupation is listed as a laborer and their annual family income is 96,

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    35 views3 pages

    Download

    Uploaded by

    syed nazira
    Sahil Shaikh Faizan has applied for admission to the B. Pharm program at Anjuman-I-Islam Kalsekar Technical Campus School of Pharmacy. He is a 22 year old Muslim male from Mumbai, India. He has completed his 10th standard from Chembur Station Municipal Urdu Secondary School in 2019 with 83% and his 12th standard (Science) from NG Acharya and DK Marathe College of Arts Science and Commerce in 2021 with 85.67%. He is seeking regular admission to the first semester of the B. Pharm program and has selected the relevant course papers. His father's occupation is listed as a laborer and their annual family income is 96,

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    of 3

    For Office Use

    Batch: Scrutiny Payment: Online/DD PI

    Only Serial:

    Anjuman-I-Islam Kalsekar Technical Campus School of Pharmacy (1151)

    Plot No. 2 & 3 ,Sector -16 , Near Thane Naka Khandagaon (New Panvel)
    Panvel

    Application No :

    University of Mumbai 2916907

    M.G.Road, Fort, Mumbai-400032, Maharashtra(India)

    Academic Year: 2022-2023 Regular


    APPLICATION FORM

    Course Applied for : B. Pharm(with Credits) - Regular - Rev16 - FYBPharm Sem I 


    (-) PRN:
    Application Date : 14/01/2023 Payment Category :

    1.Personal Information

    Candidate's Name(Regional) : साहिल


    Candidate's Name as printed on Mark SHAIKH SAHIL FAIZAN
    sheet : [*This name will appear on all University records/documents]

    Father's/Husband's Name : FAIZAN Mother's Name : SALMA

    Marital Status : UnMarried Mother Tongue : Urdu


    Place Of Birth : Azamgarh Gender : Male Date of Birth (DD/MM/YYYY) : 22/02/2004
    Blood Group : Religion : Muslim Country of Citizenship : India
    Is Student NRI/ Foreign National : No Domicile State: Maharashtra
    Address For Correspondence :
    City/Town/Village : Mumbai
    State : Maharashtra District : Mumbai Suburban Tehsil : Kurla Location Area : Urban
    Suburban
    Address (House
    Aa Indira Nagar No.02 Nimoniya Baug Govandi Mumbai 400043 Azamgarh Pin Code : 400043
    no,street/area/suburb etc.) :
    Permanent Address :
    City/Town/Village : Mumbai
    State : Maharashtra District : Mumbai Suburban Tehsil : Kurla Location Area : Urban
    Suburban
    Address : Aa Indira Nagar No.02 Nimoniya Baug Govandi Mumbai 400043 Azamgarh Pin Code : 400043
    Contact details
    Mobile Number 9324195110 Email ID: sahil203692@gmail.com
    2.Legal Reservation Information
    Category Type : Open Category : GEN
    Is Guardian from EBC (Economic Backward
    Is Specially Abled? No
    Class)?  Yes
    3.Social Information(Additional Inforamtion)
    Not Applicable
    Paper Selected for:
    Sem I
    BPH_C_101_T - General Chemistry BPH_C_102_T - Dispensing and Community Pharmacy
    BPH_C_103_T - Anatomy, Physiology & Pathophysiology I BPH_C_104_T - Biochemistry I
    BPH_C_105_T - Communication Skills and Ethics (NUES) BPH_C_106_L - General Chemistry Lab
    BPH_C_107_L - Dispensing and Community Pharmacy Lab BPH_C_108_L - Anatomy, Physiology & Pathophysiology Lab
    Sem II

    BPH_C_201_T - Anatomy, Physiology and Pathophysiology II BPH_C_202_T - Biochemistry II


    BPH_C_203_T - Pharmacognosy I BPH_C_204_T - Hospital Pharmacy and Drug Store Management
    BPH_C_205_T - Environmental Science BPH_C_206_L - Pharmacognosy Lab I
    BPH_C_207_L - Biochemistry Lab BPH_C_208_L - Computer Lab

    Medium of Instruction : English


    4.Guardian Information
    Occupation of Guardian : Laborer Annual Income of Guardian : 96000
    5.Educational Details
    Month
    Name of Name of Board/University and and Year Exam Certificate Mark
    Name of School/College Out of CGPA %
    Examination State of University of Seat No. No. Obtained
    Passing
    MAHARASHTRA STATE BOARD
    CHEMBUR STATION
    OF SECONDARY AND HIGHER March
    Std 10th MUNCIPAL URDU A325136 256726 415.00 500.00 --
    -
    -- 83.00
    SECONDARY 2019
    SECONDARY SCHOOL
    EDUCATION,Maharashtra
    MAHARASHTRA STATE BOARD NG ACHARYA AND DK
    Std 12th OF SECONDARY AND HIGHER MARATHE COLLEGE OF
    July 2021 M071620 263208 514.00 600.00 --
    -
    -- 85.67
    Science SECONDARY ARTS SCIENCE AND
    EDUCATION,Maharashtra COMMERECE
    Your Last Qualifying Exam: HSC/Std 12th [Science]
    7.Other Information
    Would you like to apply for Hostel accommodation required NA
    Required Documents and Certificates Section:
    Passing Certificate of Std 12th / Statement of Marks of Std 12th OR Original Passing Certificate /Statement of Marks of Last Qualifying Exam like
    degree,diploma,etc.

    Passing Certificate of Std 10th.

    Leaving Certificate.

    Domicile Certificate.

    Self affidavit regarding gap in academic year (Gap Certificate).

    Statement of Marks of Std 10th.

    Birth Certificate.

    Father’s Income certificate from Tahsildar.

    Passing Certificate of Std. 10th.

    Passing Certificate of Std. 12th/Statement of Marks of std.12th.

    Residence Proof (Any) – Copy of Voter ID/ Driving License/Telephone Bill /Electricity Bill /Ration Card/ Society Letter/ Agreement.

    School/College Leaving Certificate.

    Self-affidavit regarding Gap in AY (Gap Certificate) –Rs.50/- or Rs.100/- stamp paper Notarized.

    Statement of CET/Certificate of CET.

    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
    Application No :2916907 (SHAIKH SAHIL FAIZAN)
    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 )
    For College/Institute/Study Center Use Only
    Designation Remarks / Particulars / Recommendations Signature and Date
    Admission Clerk
    Admission
    Committee
    Accountant/Cashier Cash Received: INR Receipt No.: Date:
    Registrar/Office
    Superintendent
    Document printed on Sat Jan 14 2023 18:14:46 GMT+0530 (India Standard Time)

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