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Lalit

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Chikitsak Samuhas S.S. And L.S.Patkar College of Arts And Science, V.P. Varde College of Commerce Application No
and Economics (156)
S. V. Road. Boriwali :
University of Mumbai
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
1778833
Academic Year: 2023-2024 Regular
APPLICATION FORM

Course Applied for : B.Sc. (Computer Science) (Autonomous)(with


Credits) - Regular - CBCS - F.Y.B.Sc. (Computer Science) (Autonomous) Sem PRN:
I  (-)

Application Date : 20/06/2023 Payment Category :


1.Personal Information
Candidate's Name(Regional) : गुप्ता आदित्य रामशंकर
Candidate's Name as printed GUPTA ADITYA RAMASHANKAR
on Mark sheet : [*This name will appear on all University records/documents]
Mother's
Father's/Husband's Name : RAMASHANKAR RANI DEVI
Name :
Mother
Marital Status : UnMarried Hindi
Tongue :
Place Of Birth : UTTARPRADESH Gender : Male Date of Birth (DD/MM/YYYY) : 03/03/2006
Blood Group : Religion : Hindu Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
District : Mumbai City/Town/Village :
State : Maharashtra Tehsil : Boriwali Location Area : Urban
Suburban MUMBAI
Address (House
LALJI PADA KESHARIA HANUMAN MANDIR SANJA NAGAR LAL TIWARI
no,street/area/suburb Pin Code : 400067
ROAD
etc.) :
Permanent Address :
District : Mumbai City/Town/Village :
State : Maharashtra Tehsil : Boriwali Location Area : Urban
Suburban MUMBAI
LALJI PADA KESHARIA HANUMAN MANDIR SANJA NAGAR LAL TIWARI
Address : Pin Code : 400067
ROAD
Contact details
Mobile
9326015975 Email ID: ag0692549@gmail.com
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 I
BSC CS 1.1 - Paper 1 BSC CS 1.2 - Paper 2
BSC CS 1.3 - Paper 3 BSC CS 1.4 - Paper 4
Sem II
BSC CS 2.1 - Paper 5 BSC CS 2.2 - Paper 6
BSC CS 2.3 - Paper 7 BSC CS 2.4 - Paper 8

Medium of Instruction : English


4.Guardian Information
Occupation of Guardian : Business Annual Income of Guardian : 0
5.Educational Details
Month
Name of Name of Board/University Name of and Exam Certificate Mark Out
CGPA %
Examination and State of University School/College Year of Seat No. No. Obtained of
Passing
MAHARASHTRA STATE
BOARD OF SECONDARY AND HOLY INFANT July
Std 10th A292813 -- 311.00 500.00 -- - -- 62.20
HIGHER SECONDARY HIGH SCHOOL 2021
EDUCATION,Maharashtra
MAHARASHTRA STATE NIRMAL JUNIOR
Std 12th BOARD OF SECONDARY AND COLLEGE OF May
M088272 -- 252.00 600.00 -- - -- 42.00
Science HIGHER SECONDARY COMMERCE AND 2023
EDUCATION,Maharashtra SCIENCE
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.

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 :1778833
(GUPTA ADITYA RAMASHANKAR) 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 Signature and
Remarks / Particulars / Recommendations
Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: INR Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Wed Jun 21 2023 16:44:02 GMT+0530 (India Standard Time)

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