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For Office Use
Batch: Scrutiny Payment: Online/DD PI
Only Serial:
St. Xaviers College (231)
5, Mahapalika Marg.Mumbai Mumbai Application No :
University of Mumbai 185503
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
Academic Year: 2023-2024
Regular
APPLICATION FORM
Course Applied for : B.Com. (A.and F.)(Autonomous)(with Credits) - Regular - ABC ID: 405-852-538-121 PRN:
CBCS - F.Y. B.Com. (A. and F.)(Autonomous) Sem I (-)
Application Date : 31/05/2023 Payment Category :
1.Personal Information
Candidate's Name(Regional) : हिंदी
Candidate's Name as printed on DARJI SALONI
Mark sheet : [*This name will appear on all University records/documents]
Father's/Husband's Name : JAYANITIBHAI Mother's Name : DAKSHA
Marital Status : UnMarried Mother Tongue : Gujarati
Place Of Birth : Gujarat Gender : Female Date of Birth (DD/MM/YYYY) : 21/08/2005
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 : Mumbai Suburban Tehsil : Andheri Location Area : Urban
Mumbai
Address (House
Room No 32 Achota Pandey Chawl S.V. Road Near Bhawani Chowk Ambawadi Pin Code : 400068
no,street/area/suburb etc.) :
Permanent Address :
City/Town/Village :
State : Maharashtra District : Mumbai Suburban Tehsil : Andheri Location Area : Urban
Mumbai
Address : Room No 32 Achota Pandey Chawl S.V. Road Near Bhawani Chowk Ambawadi Pin Code : 400068
Contact details
Mobile Number 7738552711 Email ID: nikhil.j.darji17@gmail.com
2.Legal Reservation Information
Category Type : Open Category : GEN
Is Guardian from EBC (Economic Backward
Is Specially Abled? No
Class)? Yes
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem I
AF1001 - Paper 1 AF1002 - Paper 2
AF1003 - Paper 3 AF1004 - Paper 4
Sem II
AF2001 - Paper 1 AF2002 - Paper 2
AF2003 - Paper 3 AF2004 - Paper 4
Medium of Instruction : English
4.Guardian Information
Occupation of Guardian : Business Annual Income of Guardian : 250000
5.Educational Details
Month
Name of Name of Board/University and State Name of Exam Certificate Mark
and Year Out of CGPA %
Examination of University School/College Seat No. No. Obtained
of Passing
MAHARASHTRA STATE BOARD
OF SECONDARY AND HIGHER XAVIER'S HIGH
Std 10th June 2021 A305698 309145 364.00 500.00 -- - -- 72.80
SECONDARY SCHOOL
EDUCATION,Maharashtra
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Month
Name of Name of Board/University and State Name of Exam Certificate Mark
and Year Out of CGPA %
Examination of University School/College Seat No. No. Obtained
of Passing
MAHARASHTRA STATE BOARD
Std 12th OF SECONDARY AND HIGHER L.J.N.J.MAHAILA
May 2023 M272571 -- 538.00 600.00 -- - -- 89.67
Commerce SECONDARY MAHAVIDYALAYA
EDUCATION,Maharashtra
Your Last Qualifying Exam: HSC/Std 12th [Commerce]
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.
Passing Certificate of Std. 12th/Statement of Marks of std.12th.
School/College 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 :185503 (DARJI SALONI) 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 Wed May 31 2023 11:39:18 GMT+0530 (India Standard Time)
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