For Office Use

Batch: Scrutiny Payment: Online/DD PI

Only Serial:

Government Engineering College , Ballarpur Road, Babupeth , Chandrapur. (311)

Babupeth, Chandrapur, Maharashtra, India Chandrapur Application No :
Gondwana University
MIDC Road Complex, Gadchiroli-442605,MH.(India)
28635
Academic Year: 2024-2025 Regular
APPLICATION FORM

Course Applied for : B.TECH.(with Credits) - Regular - MODEL

CURRICULUM - MECHANICAL ENGINEERING - SY B.TECH. SEM III ABC ID: 572-797-773-593 PRN:
(BTECH_MODEL)

Application Date : 29/09/2024 Payment Category :

Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) : शेख हाजी हमीद
Candidate's Name as printed
SHAIKH HAJI HAMID
on School leaving/Passing
[*This name will appear on all University records/documents]
Certificate :
Mother's
Father's/Husband's Name : SHAIKH HAMID FARZANA
Name :
Mother
Marital Status : UnMarried Urdu
Tongue :
Place Of Birth : Pathri Gender : Male Date of Birth (DD/MM/YYYY) : 15/07/2004
Blood Group : Religion : Muslim Country of Citizenship : India
Weight : Not
Height : Not Available Hemoglobin : Not Available
Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
City/Town/Village :
State : Maharashtra District : Parbhani Tehsil : Pathri Location Area : Urban
PATHRI
Address (House
no,street/area/suburb Amer Manzil INDIRA Nagar Pathri Pin Code : 431506
etc.) :
Permanent Address :
City/Town/Village :
State : Maharashtra District : Parbhani Tehsil : Pathri Location Area : Urban
PATHRI
Address : Amer Manzil INDIRA Nagar Pathri Pin Code : 431506
Contact details
Mobile
7057406944 Email ID: bagwanhaji644@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : OBC Sub Category : Bagwan
Reserved
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? Yes
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
SEM III
BSC-202 - Mathematics-III ESC-202 - Engineering Mechanics
ESC-202P - Engineering Mechanics(PR) PCC-ME 205 - Material Engineering
 PCC-ME 205P - Material Engineering(PR) PCC-ME201 - Thermodynamics
PCC-ME207 - MACHINE DRAWING (PR) PCC-ME208 - Fluid Mechanics
SEM IV

ESC-201 - Basic Electronics Engineering PCC-ME202 - Applied Thermodynamics

PCC-ME203 - Fluid Mechanics PCC-ME203P - Fluid Mechanics(PR)
PCC-ME204 - Strength of Materials PCC-ME204P - Strength of Materials(PR)
PCC-ME206 - Instrumentation & Control

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Laborer Annual Income of Guardian : 50000
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
MADHYAMIK
BOARD OF SECONDARY AND March
Std 10th VIDYALAYA K178155 143040 367.00 500.00 -- - -- 73.40
HIGHER SECONDARY 2020
DEVNANDRA
EDUCATION,Maharashtra
Diploma : Maharashtra State Board of GOVERMENT
June
MECHANICAL Technical POLYTECHNIC 385782 20428633 710.00 900.00 -- - -- 78.89
2024
ENGINEERING Education,Maharashtra BEED
Your Last Qualifying Exam: MECHANICAL 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.

Statement of Marks of Std 10th

Addhar Card copy

Statement of Marks of Qualifying Exam

Leaving / Transfer Certificate

Scan copy of Academic Bank of Credit ID (ABC ID)

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 :28635
(SHAIKH HAJI HAMID) 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.

Please submit necessary documentary evidence at the time of submission of this application form at the concerned
Faculty/College

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
[COLLEGE COPY]

For Office Use

Batch: Scrutiny Payment: Online/DD PI

Only Serial:

Government Engineering College , Ballarpur Road, Babupeth , Chandrapur. (311)

Babupeth, Chandrapur, Maharashtra, India Chandrapur Application No :
Gondwana University 28635
MIDC Road Complex, Gadchiroli-442605,MH.(India)
Academic Year: 2024-2025 Regular
APPLICATION FORM

Course Applied for : B.TECH.(with Credits) - Regular - MODEL

CURRICULUM - MECHANICAL ENGINEERING - SY B.TECH. SEM III ABC ID: 572-797-773-593 PRN:
(BTECH_MODEL)

Application Date : 29/09/2024 Payment Category :

Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) : शेख हाजी हमीद
Candidate's Name as printed
SHAIKH HAJI HAMID
on School leaving/Passing
[*This name will appear on all University records/documents]
Certificate :
Mother's
Father's/Husband's Name : SHAIKH HAMID FARZANA
Name :
Mother
Marital Status : UnMarried Urdu
Tongue :
Place Of Birth : Pathri Gender : Male Date of Birth (DD/MM/YYYY) : 15/07/2004
Blood Group : Religion : Muslim Country of Citizenship : India
Weight : Not
Height : Not Available Hemoglobin : Not Available
Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
City/Town/Village :
State : Maharashtra District : Parbhani Tehsil : Pathri Location Area : Urban
PATHRI
Address (House
no,street/area/suburb Amer Manzil INDIRA Nagar Pathri Pin Code : 431506
etc.) :
Permanent Address :
City/Town/Village :
State : Maharashtra District : Parbhani Tehsil : Pathri Location Area : Urban
PATHRI
Address : Amer Manzil INDIRA Nagar Pathri Pin Code : 431506
Contact details
Mobile
7057406944 Email ID: bagwanhaji644@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : OBC Sub Category : Bagwan
Reserved
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? Yes
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
SEM III
BSC-202 - Mathematics-III ESC-202 - Engineering Mechanics
 ESC-202P - Engineering Mechanics(PR) PCC-ME 205 - Material Engineering
PCC-ME 205P - Material Engineering(PR) PCC-ME201 - Thermodynamics
PCC-ME207 - MACHINE DRAWING (PR) PCC-ME208 - Fluid Mechanics
SEM IV

ESC-201 - Basic Electronics Engineering PCC-ME202 - Applied Thermodynamics

PCC-ME203 - Fluid Mechanics PCC-ME203P - Fluid Mechanics(PR)
PCC-ME204 - Strength of Materials PCC-ME204P - Strength of Materials(PR)
PCC-ME206 - Instrumentation & Control

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Laborer Annual Income of Guardian : 50000
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
MADHYAMIK
BOARD OF SECONDARY AND March
Std 10th VIDYALAYA K178155 143040 367.00 500.00 -- - -- 73.40
HIGHER SECONDARY 2020
DEVNANDRA
EDUCATION,Maharashtra
Diploma : Maharashtra State Board of GOVERMENT
June
MECHANICAL Technical POLYTECHNIC 385782 20428633 710.00 900.00 -- - -- 78.89
2024
ENGINEERING Education,Maharashtra BEED
Your Last Qualifying Exam: MECHANICAL 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.

Statement of Marks of Std 10th

Addhar Card copy

Statement of Marks of Qualifying Exam

Leaving / Transfer Certificate

Scan copy of Academic Bank of Credit ID (ABC ID)

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 :28635
(SHAIKH HAJI HAMID) 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.

Please submit necessary documentary evidence at the time of submission of this application form at the concerned
Faculty/College

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 Sun Sep 29 2024 14:33:11 GMT+0530 (India Standard Time)