For Office Use
Batch: Scrutiny Payment: Online/DD PI
Only Serial:
Mithibai College of Arts, Chauhan Institute of Science and Amrutben Jivanlal College of Commerce Application No
And Economics (132)
Bhakti Vedant Marg, Vile Parle West Mumbai :
University of Mumbai
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
1828187
Academic Year: 2023-2024 Regular
APPLICATION FORM
Course Applied for : B.Sc.(Honours)(Autonomous)(with Credits) - ABC ID: 680-935-249-439 PRN:
Regular - CBCS - Psychology - F.Y.B.Sc.(Honours)(Autonomous) Sem I (-)
Application Date : 22/06/2023 Payment Category :
1.Personal Information
Candidate's Name(Regional) : माज़ अहमद
Candidate's Name as printed MAAZ AHMAD
on Mark sheet : [*This name will appear on all University records/documents]
REYAZUDDIN Mother's
Father's/Husband's Name : SHEFTA BANO
AHMAD Name :
Mother
Marital Status : UnMarried Hindi
Tongue :
Place Of Birth : Varanasi Gender : Male Date of Birth (DD/MM/YYYY) : 22/02/2004
Blood Group : OPositive Religion : Muslim Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Uttar Pradesh
Address For Correspondence :
City/Town/Village : Location Area :
State : Uttar Pradesh District : Varanasi Tehsil : Tehsil Sadar
Varanasi Semiurban
Address (House
no,street/area/suburb S30/1 E-15 VDA Colony Shivpur Pin Code : 221002
etc.) :
Permanent Address :
City/Town/Village : Location Area :
State : Uttar Pradesh District : Varanasi Tehsil : Tehsil Sadar
Varanasi Semiurban
Address : S30/1 E-15 VDA Colony Shivpur Pin Code : 221002
Contact details
Mobile
9935364462 Email ID: mj13july@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : GEN
Open
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem I
BSCPH101 - Paper 1 BSCPH102 - Paper 2
BSCPH103 - Paper 3 BSCPH104 - Paper 4
Sem II
BSCPH201 - Paper 1 BSCPH202 - Paper 2
BSCPH203 - Paper 3 BSCPH204 - Paper 4
Medium of Instruction : English
4.Guardian Information
Occupation of Guardian : Service Annual Income of Guardian : 360000
5.Educational Details
Name of Month
Name of Name of Exam Certificate Mark Out
Board/University and and Year CGPA %
Examination School/College Seat No. No. Obtained of
State of University of Passing
CENTRAL BOARD OF SANT
SECONDARY ATULANAND
Std 10th May 2021 23294948 2125386 450.00 500.00 -- - -- 90.00
EDUCATION,Uttar CONVENT
Pradesh SCHOOL
CENTRAL BOARD OF SANT
Std 12th SECONDARY ATULANAND
May 2023 23769436 -- 379.00 500.00 -- - -- 75.80
Science EDUCATION,Uttar CONVENT
Pradesh SCHOOL
Your Last Qualifying Exam: HSC/Std 12th [Science]
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.
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 :1828187
(MAAZ AHMAD) 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 Thu Jun 22 2023 00:03:04 GMT+0530 (India Standard Time)
