Progressive Education Society's
Modern College of Arts, Science and Commerce
Shivajinagar, Pune - 411005
(+9120) 2553 5468 / 2553 5102 / 2553 5927, Email ID : info@moderncollegepune.com
Admission Form Details (Academic Year : 2018-19)
Form Verification (For Office Use Only) Fill Date : 12/06/2018 07:23 PM - Print Date : 12/06/2018 07:23 PM
Sign. Sign.
Div & Subject Alot. Auth Division Roll No. Rcpt. Made By Rcpt. No. Amount Date
Sign. Sign.
Form Checked By Scholarship Verification Fee Category Caste Category Caste Member ID
INDIAN Maharashtra O.B.C No
Nationality State of Resident Caste Category Is Handicapped
Registration Information
Admission Form Number : 301557
Registration Number : 1800069124
Admission Type : Section : Class :
Provisional U.G F.Y.B.SC.
Division : Fee Category : Caste Category :
GRANT FEE PAYING O.B.C
Form No. (Merit/Adm.) : Uni./Board Registration No. : Eligibility No.(UG & PG) :
N.A. N.A. N.A.
CAP Application Kit No. : Adhaar Card No. : Pan Card No. :
N.A. N.A. N.A.
Saral ID. :
N.A.
Student's Information
Student's Name :
TANDI MANISHA MALLARAM
Father's Name : Mother's Name :
MALLARAM TANDI GOGALI TANDI
Local Address :
S.NO 13/11 Gangotri Heights FLAT NO B1 PAWAR NAGAR
THERGAON PUNE 411033
Location : Taluka : District :
Thergaon Mulshi Pune
State : Country : Pin Code :
Maharashtra INDIA 411033
Permanent Address :
S.NO 13/11 Gangotri Heights FLAT NO B1 PAWAR NAGAR
Layout, design & style of this form is copyright of Vriddhi Software Solutions Pvt Ltd., Page 1
support@vriddhisoftware.com.(Form No.:301557)
THERGAON PUNE 411033
Location : Taluka : District :
Thergaon Mulshi Pune
State : Country : Pin Code :
Maharashtra INDIA 411033
Email ID : Mobile No. :
ranjeettandi0008@gmail.com 9649881355
Parent's Email : Father's Mobile No. :
mallaramja437@gmail.com 9860765070
Father's Profession : Father's Occupation : Phone No 1 :
BUISNESS MAN N.A. 9823040557
Phone No 2 : Fax No : Gender :
9823040557 N.A. Female
Birth Date : Birth Place : Delivery Place :
05/05/2000 NAGAUR N.A.
Nationality : Mother Tongue : Marital Status :
INDIAN Marwadi Single
Occupational Status: Blood Group : Handicap :
Unemployed O+ No
Is Organ Donor : Conveyance Use : Religion :
N.A. Bus HINDU
Caste : Sub Caste : Caste Validity No.:
--- --- N.A.
Is Minority : Minority Detail : Ration Card Type :
N.A. N.A. No
Computer Course : Specialization: Family Doctor Name :
None Hindi Language Mukund DIGGIKAR
Family Doctor Mobile :
9881223887
Guardian's Information
Guardian's Name :
N.A.
Adress Line 1 :
N.A.
Adress Line 2 :
N.A.
Location : Taluka : District :
N.A. N.A. N.A.
State : Country : Pin Code :
N.A. INDIA N.A.
Relation With Student: Guardian's Email :
N.A. N.A.
Guardian's Mobile : Guardian's Phone : Guardian's Fax :
N.A. N.A. N.A.
Parent's Company Information
Company Name :
N.A.
Company Email :
N.A.
Company Web Site :
N.A.
Company Adress Line 1 :
N.A.
Layout, design & style of this form is copyright of Vriddhi Software Solutions Pvt Ltd., Page 2
support@vriddhisoftware.com.(Form No.:301557)
Company Adress Line 2 :
N.A.
Location : Taluka : District :
N.A. N.A. N.A.
State : Country : Pin Code :
N.A. N.A. 411033
Mobile No : Phone No. : Fax No. :
N.A. N.A. N.A.
Last Year's Details with (TC/LC)/Migration/Eligibility Information
Last Attended Institute Name :
SMT .GODAVARI HINDI VIDYALAY & JUNIOR COLLEGE
Last Attended Examining Body (Board/University) :
MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION
Last Attended Class : Last Attended College/School UDISE Code :
12TH N.A.
Eligibility : State of Residence : Last Qualified Exam :
N.A. M.S. 12TH
Passing Month : Passing Year : Percentage :
Feb 2018 80.15
Result : Attempt : Exam Center :
I Class 1st 0065
Seat No. : T.C./L.C. No. : T.C./L.C. Date :
P024991 7022 N.A.
Migration Cert. No. : Migration Cert. Issue Date : Gap :
N.A. N.A. N.A.
Current Year's Information
Other Activity :
(None)
Short Term Course Offered by Inst. : Preparing for Competetive Exam :
N.A. N.A.
Availed Earn & Learn Scheme :
N.A.
Subject's Information
Subject Name Subject Code Subject Group
1) PHYSICS THEORY PAPER I 71210 Optional Group - G
2) PHYSICS THEORY PAPER II 71220 Optional Group - G
3) PHYSICS PRACTICAL 71230 Optional Group - G
4) CHEMISTRY THEORY PAPER I 71310 Optional Group - G
5) CHEMISTRY THEORY PAPER II 71320 Optional Group - G
6) CHEMISTRY PRACTICAL 71330 Optional Group - G
7) BOTANY THEORY PAPER I 71410 Optional Group - G
8) BOTANY THEORY PAPER II 71420 Optional Group - G
9) BOTANY PRACTICAL 71430 Optional Group - G
10) ZOOLOGY THEORY PAPER I 71510 Optional Group - G
11) ZOOLOGY THEORY PAPER II 71520 Optional Group - G
12) ZOOLOGY PRACTICAL 71530 Optional Group - G
13) PHYSICAL EDUCATION 79990 Optional Group - G
Layout, design & style of this form is copyright of Vriddhi Software Solutions Pvt Ltd., Page 3
support@vriddhisoftware.com.(Form No.:301557)
List of Documents Attached
1) AADHAAR Card 2) Marksheet (XI)
3) Original L.C. 4) Xerox Mark Sheet (10Th)
5) Xerox Mark Sheet (12Th)
TANDI MANISHA MALLARAM TANDI MANISHA MALLARAM
Scanned Signature Student's Signature
Layout, design & style of this form is copyright of Vriddhi Software Solutions Pvt Ltd., Page 4
support@vriddhisoftware.com.(Form No.:301557)
ANTI RAGGING AFFIDAVIT BY THE STUDENT
Registration No. :1800069124 Date : 12/06/2018 07:23 PM
1. I, TANDI MANISHA MALLARAM S/O or D/O Mr./Mrs./Ms. MALLARAM TANDI having been
admitted to Progressive Education Society's Modern College of Arts, Science and Commerce
have received a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher Educational
Institutions, 2009, (hereinafter called the Regulations) carefully read and fully understood the provisions
contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penal and administrative action that is liable to be taken against me in case I am found guilty for abetting
ragging, actively or passively, or being part of a conspiracy to promote ragging.
4. I hereby solemnly aver and undertake that I will not indulge in any behaviour or act that may beconstituted
as ragging under clause 3 of the Regulations.I will not participate in or abet or propagatethrough any act of
commission or omission that may be constituted as ragging under clause 3 of the Regulations.
5. I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of the
Regulations, without prejudice to any other criminal action that may be taken against me under any penallaw or
any law for the time being in force.I hereby declare that I have not been expelled or debarred fromadmission in
any institution in the country on account of being found guilty of, abetting or being part of a conspiracy to
promote, ragging; and further affirm that, in case the declaration is found to be untrue, I am aware that my
admission is liable to be canceled.
Declared on ______________________
__________________________________
Signature of Student
Name : TANDI MANISHA MALLARAM
Adress : S.NO 13/11 Gangotri Heights FLAT NO B1 PAWAR NAGAR, Mulshi, Thergaon, Pune, ,
Maharashtra, INDIA, 411033
Verification
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is
false and nothing has been concealed or misstated therein.
Verified at _________________________________ on _________________________________
Signature of Student
(NOTE: There is no need to get your affidavits printed on any stamp paper or get it signed by an Notary
or an oath Commissioner.)
Layout, design & style of this form is copyright of Vriddhi Software Solutions Pvt Ltd., Page 5
support@vriddhisoftware.com.(Form No.:301557)
AFFIDAVIT BY PARENT/GUARDIAN
Registration No. :1800069124 Date : 12/06/2018 07:23 PM
1. I Mr./Mrs./Ms., MALLARAM TANDI father/mother/guardian of TANDI MANISHA MALLARAM having
been admitted to Progressive Education Society's Modern College of Arts, Science and
Commerce have received a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher
Educational Institutions, 2009, (hereinafter called the Regulations) carefully read and fully understood the
provisions contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penaland administrative action that is liable to be taken against my ward in case he/she is found guilty of or
abetting ragging, actively or pasively, or being part of a conspiracy to promote ragging.
4. I hereby solemnly aver and undertake that My ward will not indulge in any behaviour or act that may be
constituted as ragging under clause 3 of the Regulations. My ward will not participate in or abet or propagate
through any act of commission or omission that may be constituted as ragging under clause 3 of the
Regulations.
5. I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to clause 9.1 of
the Regulations, without prejudice to any other criminal action that may be taken against my ward under any
penal law or any law for the time being in force.
6. I hereby declare that my ward has not been expelled or debarred from admission in any institution in the
country on account of being found guilty of, abetting or being part of a conspiracy to promote, ragging; and
further affirm that, in case the declaration is found to be untrue, the admission of my ward is liable to be
cancelled.
Declared on ______________________
__________________________________
Signature of Parent/Guardian
Name : MALLARAM TANDI
Adress : S.NO 13/11 Gangotri Heights FLAT NO B1 PAWAR NAGAR, Mulshi, Thergaon, Pune, ,
Maharashtra, INDIA, 411033
Verification
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is
false and nothing has been concealed or misstated therein.
Verified at _________________________________ on _________________________________
Signature of Parent/Guardian
(NOTE: There is no need to get your affidavits printed on any stamp paper or get it signed by an Notary
or an oath Commissioner.)
Layout, design & style of this form is copyright of Vriddhi Software Solutions Pvt Ltd., Page 6
support@vriddhisoftware.com.(Form No.:301557)
Roll No./Admission No.
(For Office Use)
Form Fee : 50/-
APPLICATION FOR ELIGIBILITY
(For Graduate/Post Graduate Courses)
I wish to apply for the Eligibility for the academic year 2018 - 2019
1. Name of the Course to wish application is sought
B.SC(F.Y.B.SC.) Year:1st/2nd/3rd/4th/5th
2. Name in full of the applicant(in English Capital letters)
Name as per last Mark Sheet should be mentioned. N.R.I. student should write their names as it apperas in Passport
TANDI MANISHA MALLARAM
3. Mother's Name : GOGALI TANDI
4. Nationality : INDIAN 5. Type : Maharashtrian
6. Gender : FEMALE 7. Birth Date (DD/MM/YYYY) : 05/05/2000
8. Reserved Category
Do you belong to any of the following Reserved Categories?
If so attach a certificate of Competent Authority in support of it.
Open SC ST DT(A) NT(B) NT(C) NT(D) OBC SBC
Do you belong to the creamy layer of NT(C), NT(D) and OBC? Yes/No
If you do not belong to the creamy layer, submit a certificate of a Competent Authority in support of it.
9. Are you a physically handicapped? No
Particulars of Qualifying Examination
1. Name of the Course : 12TH
2. Name of the University : MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY
EDUCATION
3. Name of the College/Institute/University Dept. : SMT .GODAVARI HINDI VIDYALAY & JUNIOR COLLEGE
Seat No Month & Year of Passing Percentag Class/Grade
P024991 Feb/2018 80.15 I Class
Please specify Educational Gap Details if any
Name of Examination Seat No. Month & Year of Percentag Class/Grade
10. Are you belong to the minority ? yes / No (if yes Please specify type which has given below)
Linguistic : _____________________ Religious : ______________________
Signature of Candidate
Copies of Following attested certificates are annexed to application form
1.Statement of Marks of the qualifying examination
2.Education Gap certificate
3.Affidavit for change in name
4.Domicile Certificate
5.Caste certificate (For reserved category candidates)
6.Cast validity certificate (For reserved category candidates)
7.Transfer Certificate
Layout, design & style of this form is copyright of Vriddhi Software Solutions Pvt Ltd., Page 7
support@vriddhisoftware.com.(Form No.:301557)
