STUDENT COPY
ABHINAV EDUCATION SOCIETY`s Law and M.B.A. College (62160)
ABHINAV EDUCATION SOCIETY,NEAR BOMBAY DHABA,KATRAJ- DEHU BYPASS,AMBEGAON BK. Haveli
Yashwantrao Chavan Maharashtra Open University Application No :
Dnyangangotri Near Gangapur Dam, Nashik, Pin Code-422222, Maharashtra(India)
Academic Year: 2022-2023
470084
Distance Education
YCMOU Study Center Submission Slip
ADMISSION FORM
Instruction:
Please submit copy of this submission slip with following list of document to Study Center for Recommendation of
Program for Admission and/or Recommendation of Scholarship.
Please note that application shall be considered for admission only after recommendation by study center
If recommendation by study center not completed before last date of admission your application will be automatically
cancelled. Please note that university will not refund the fees in case of rejection by study center for want of Eligibility.
Course Applied for : B.A. in (MCJ)(with Credits) - Distance Education - 2000 Pattern - F.Y.B.A. (MCJ)
(G15)
PRN:
Application Date : 30/08/2022 Payment Category :
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) : भगत व ल वजय
BHAGAT SWAPNIL VIJAY
Candidate's Name as printed on
[*This name will appear on all University
School leaving/Passing Certificate :
records/documents]
Father's/Husband's Name : VIJAY Mother's Name : ANURADHA
Marital Status : Married Mother Tongue : Marathi
Place Of Birth : Pune Gender : Male Date of Birth (DD/MM/YYYY) : 11/04/1988
Blood Group : BPositive Religion : Hindu 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 : Location Area :
State : Maharashtra District : Pune Tehsil : Haveli
Pune Semiurban
Address (House
no,street/area/suburb Flat No1 Prahalad Smruti Bulding Sainath Collney Lane No 2 Manjri Pin Code : 412307
etc.) :
Permanent Address :
City/Town/Village : Location Area :
State : Maharashtra District : Pune Tehsil : Haveli
Pune Semiurban
Address : Flat No1 Prahalad Smruti Bulding Sainath Collney Lane No 2 Manjri Pin Code : 412307
Contact details
Mobile Primary Email ID:
9766996691
Number swapnilbhagat7373@gmail.com
2.Legal Reservation Information
Category Type :
Category : OBC Sub Category : MALI (PHULMALI)
Reserved
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
F.Y.B.A. (MCJ)
GKN101 - Foundation Course of General Knowledge & Social HEN101 - Founadation Course of Hindi & English Lanuage
Awareness HUM101 - Foundation Course of Humanities
OPN101 - Foundation Course of Self Study Skills MAR101 - Marathi
SOC101 - Foundation Course of Social Sciences
S.Y.B.A. (MCJ)
Medium of Instruction : Marathi
Admission Fee Payment
Fee Category : Regular Fees Over All Payment Status: : Paid
Details
Adm Exam Fee - 300 Alumni Membership Fee - 2
Tution Fee - 250 Registration Fee - 200
Development Fund Fee - 250 Other Fee - 200
Total : 1202
Payment
Installment Amount Transaction Date Transaction Number Transaction Type
Status
1 1202 Paid 30/08/2022 10:30:55 2120881661898655340 Online Payment
4.Guardian Information
Occupation of Guardian : Annual Income of Guardian :
5.Educational Details
Month
Exam
Name of Name of Board/University and Name of and Year Certificate Mark Out
Seat CGPA %
Examination State of University School/College of No. Obtained Of
No.
Passing
MAHARASHTRA STATE BOARD
ANNASAHEB
Std 12th OF SECONDARY AND HIGHER February
MAGAR P173610 071475 383.00 600.00 -- - -- 63.83
MCVC SECONDARY 2009
COLLAGE
EDUCATION,Maharashtra
Your Last Qualifying Exam: HSC [MCVC]
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Statement of Marks of Qualifying Exam (पा ता परी ेची गुण प का)
Passing Certificate of Std 12th / Statement of Marks of Std 12th.
Leaving Certificate.
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 :470084
(BHAGAT SWAPNIL VIJAY) 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
[STUDY CENTER COPY]
ABHINAV EDUCATION SOCIETY`s Law and M.B.A. College (62160)
ABHINAV EDUCATION SOCIETY,NEAR BOMBAY DHABA,KATRAJ- DEHU BYPASS,AMBEGAON BK. Haveli
Yashwantrao Chavan Maharashtra Open University
Application No :
Dnyangangotri Near Gangapur Dam, Nashik, Pin Code-422222, Maharashtra(India)
Academic Year: 2022-2023
470084
Distance Education
YCMOU Study Center Submission Slip
ADMISSION FORM
Instruction:
Please submit copy of this submission slip with following list of document to Study Center for Recommendation of
Program for Admission and/or Recommendation of Scholarship.
Please note that application shall be considered for admission only after recommendation by study center
If recommendation by study center not completed before last date of admission your application will be automatically
cancelled. Please note that university will not refund the fees in case of rejection by study center for want of Eligibility.
Course Applied for : B.A. in (MCJ)(with Credits) - Distance Education - 2000 Pattern - F.Y.B.A. (MCJ) PRN:
(G15)
Application Date : 30/08/2022 Payment Category :
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) : भगत व ल वजय
BHAGAT SWAPNIL VIJAY
Candidate's Name as printed on
[*This name will appear on all University
School leaving/Passing Certificate :
records/documents]
Father's/Husband's Name : VIJAY Mother's Name : ANURADHA
Marital Status : Married Mother Tongue : Marathi
Place Of Birth : Pune Gender : Male Date of Birth (DD/MM/YYYY) : 11/04/1988
Blood Group : BPositive Religion : Hindu 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 : Location Area :
State : Maharashtra District : Pune Tehsil : Haveli
Pune Semiurban
Address (House
no,street/area/suburb Flat No1 Prahalad Smruti Bulding Sainath Collney Lane No 2 Manjri Pin Code : 412307
etc.) :
Permanent Address :
City/Town/Village : Location Area :
State : Maharashtra District : Pune Tehsil : Haveli
Pune Semiurban
Address : Flat No1 Prahalad Smruti Bulding Sainath Collney Lane No 2 Manjri Pin Code : 412307
Contact details
Mobile Primary Email ID:
9766996691
Number swapnilbhagat7373@gmail.com
2.Legal Reservation Information
Category Type :
Category : OBC Sub Category : MALI (PHULMALI)
Reserved
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
F.Y.B.A. (MCJ)
GKN101 - Foundation Course of General Knowledge & Social HEN101 - Founadation Course of Hindi & English Lanuage
Awareness HUM101 - Foundation Course of Humanities
OPN101 - Foundation Course of Self Study Skills MAR101 - Marathi
SOC101 - Foundation Course of Social Sciences
S.Y.B.A. (MCJ)
Medium of Instruction : Marathi
Admission Fee Payment
Fee Category : Regular Fees Over All Payment Status: : Paid
Details
Adm Exam Fee - 300 Alumni Membership Fee - 2
Tution Fee - 250 Registration Fee - 200
Development Fund Fee - 250 Other Fee - 200
Total : 1202
Payment
Installment Amount Transaction Date Transaction Number Transaction Type
Status
1 1202 Paid 30/08/2022 10:30:55 2120881661898655340 Online Payment
4.Guardian Information
Occupation of Guardian : Annual Income of Guardian :
5.Educational Details
Month
Exam
Name of Name of Board/University and Name of and Year Certificate Mark Out
Seat CGPA %
Examination State of University School/College of No. Obtained Of
No.
Passing
MAHARASHTRA STATE BOARD
ANNASAHEB
Std 12th OF SECONDARY AND HIGHER February
MAGAR P173610 071475 383.00 600.00 -- - -- 63.83
MCVC SECONDARY 2009
COLLAGE
EDUCATION,Maharashtra
Your Last Qualifying Exam: HSC [MCVC]
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Statement of Marks of Qualifying Exam (पा ता परी ेची गुण प का)
Passing Certificate of Std 12th / Statement of Marks of Std 12th.
Leaving Certificate.
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 :470084
(BHAGAT SWAPNIL VIJAY) 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 Tue Sep 06 2022 14:04:02 GMT+0530 (India Standard Time)
