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    Kaushal

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    guptacrow
    The document is an application form for admission to a computer engineering course. It contains personal details of the applicant like name, address, educational qualifications, category and other required documents. The applicant has provided all the necessary information and declared that the details provided are true.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Kaushal

    Uploaded by

    guptacrow
    10 views2 pages
    The document is an application form for admission to a computer engineering course. It contains personal details of the applicant like name, address, educational qualifications, category and other required documents. The applicant has provided all the necessary information and declared that the details provided are true.

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    kaushal

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    The document is an application form for admission to a computer engineering course. It contains personal details of the applicant like name, address, educational qualifications, category and other required documents. The applicant has provided all the necessary information and declared that the details provided are true.

    Copyright:

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

    Kaushal

    Uploaded by

    guptacrow
    The document is an application form for admission to a computer engineering course. It contains personal details of the applicant like name, address, educational qualifications, category and other required documents. The applicant has provided all the necessary information and declared that the details provided are true.

    Copyright:

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

    27/11/2022, 13:15 about:blank

    For Office Use


    Batch: Scrutiny Payment: Online/DD PI

    Only Serial:

    B.R. Harne College of Engineering and Technology, Karav (948)


    At-Karav Post- Vangani Ambarnath Application No :
    University of Mumbai 2810322
    M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
    Academic Year: 2022-2023 Regular
    APPLICATION FORM

    Course Applied for : B.E.(with Credits) - Regular - CBCS - Computer Engineering - S.E. C-Scheme Sem III PRN:
    (BECBCS1001)

    Application Date : 27/11/2022 Payment Category :


    1.Personal Information

    Candidate's Name(Regional) : साळवी कौशल दिलीप


    Candidate's Name as printed on Mark SALVI KAUSHAL DILIP
    sheet : [*This name will appear on all University records/documents]
    Father's/Husband's Name : DILIP SALVI Mother's Name : DARSHANA
    Marital Status : UnMarried Mother Tongue : Marathi
    Place Of Birth : Ratnagiri Gender : Male Date of Birth (DD/MM/YYYY) : 15/05/2003
    Blood Group : OPositive Religion : Hindu Country of Citizenship : India
    Is Student NRI/ Foreign National : No Domicile State: Maharashtra
    Address For Correspondence :
    City/Town/Village :
    State : Maharashtra District : Thane Tehsil : Kalyan Location Area : Urban
    Dombivali
    Address (House
    Room No 8,Jay Maharashtra Niwas Chawl Retibunder Road Dombivali Pin Code : 421201
    no,street/area/suburb etc.) :
    Permanent Address :
    Location Area : Not
    State : Maharashtra District : Thane Tehsil : Kalyan City/Town/Village :
    Available
    Address : Room No 8,Jay Maharashtra Niwas Devichapada Dombivali Pin Code : 0
    Contact details
    Mobile Number 9082413166 Email ID: salvikaushal21@gmail.com
    2.Legal Reservation Information
    Category Type :
    Category : OBC Sub Category : KUMBHAR
    Reserved
    Is Guardian from EBC (Economic Backward
    Is Specially Abled? No
    Class)? No
    3.Social Information(Additional Inforamtion)
    Not Applicable
    Paper Selected for:
    Sem III
    CSC301 - Engineering Mathematics-III CSC302 - Discrete Structures and Graph Theory
    CSC303 - Data Structure CSC304 - Digital Logic & Computer Architecture
    CSC305 - Computer Graphics CSL301 - Data Structure Lab
    CSL302 - Digital Logic & Computer Architecture Lab CSL303 - Computer Graphics Lab
    CSL304 - Skill Base Lab Course: Object Oriented Programming With CSM301 - Mini Project – 1 A
    Java
    Sem IV

    CSC401 - Engineering Mathematics-IV CSC402 - Analysis of Algorithm


    CSC403 - Database Management System CSC404 - Operating System
    CSC405 - Microprocessor CSL401 - Analysis of Algorithm Lab
    CSL402 - Database Management System Lab CSL403 - Operating System Lab
    CSL404 - Microprocessor Lab CSL405 - Skill Base Lab Courses: Python Programming
    CSM401 - Mini Project 1-B

    Medium of Instruction : English


    4.Guardian Information
    Occupation of Guardian : Service Annual Income of Guardian : 150000

    about:blank 1/2
    27/11/2022, 13:15 about:blank
    5.Educational Details
    Month
    Name of Name of Board/University and State of Name of Exam Certificate Mark
    and Year Out of CGPA %
    Examination University School/College Seat No. No. Obtained
    of Passing
    MAHARASHTRA STATE BOARD OF
    SECONDARY AND HIGHER DON BOSCO
    Std 10th June 2019 AO50507 082594 408.00 500.00 -- - -- 81.60
    SECONDARY HIGH SCHOOL
    EDUCATION,Maharashtra
    Diploma : S. H. JONHALE
    Maharashtra State Board of Technical
    Computer POLYTECHNIC July 2022 107408 -- 1339.00 1750.00 -- - -- 76.51
    Education,Maharashtra
    Engineering DOMBIVALI
    Your Last Qualifying Exam: Computer Engineering
    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.

    Certificate of Caste with Category.

    Leaving Certificate.

    Non Creamy Layer Certificate.

    Domicile Certificate.

    Certificate of Caste with Category.

    Domicile Certificate.

    Father’s Income certificate from Tahsildar.

    School/College Leaving Certificate.

    Statement of Marks of Std. 10th.

    Mark/Grade Statement of Semester-I

    Mark/Grade Statement of Semester-II

    Mark/Grade Statement of Semester-III

    Mark/Grade Statement of Semester-IV

    Mark/Grade Statement of Semester-V

    Mark/Grade Statement of Semester-VI

    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 :2810322 (SALVI KAUSHAL DILIP) 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 Sun Nov 27 2022 13:15:07 GMT+0530 (India Standard Time)

    about:blank 2/2

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