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0% found this document useful (0 votes)
109 views4 pages

Registration Form

Uploaded by

devfmodh10
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Ip Address : 42.106.8.

10 Date : 6/30/2024 4:52:47 PM

Gujarat State Agricultural Universities Common Admission 2024

Programme Category 1 ( B.Sc. (Hons.) Agriculture / B.Sc. (Hons.)


Horticulture / B.Sc. (Hons.) Forestry / B.Tech. (Bio Technology) )

1. Application Information

Application No : UGGSAUCA-B-01-24-9656

Applicant's Name as MODH DEV FALGUN Challan Challan


2400014387 30/06/2024
per Challan : No: Date:

2. Applicant's Details

Applicant's Full Name Father Full Name Mother Full Name


(As Per 12th Marksheet) (As Per Adhar Card) (As Per Adhar Card)
MODH DEV FALGUN FALGUN KANTILAL MODH ROHITA FALGUN MODH

3. Information of Bank

Bank Name : STATE BANK OF INDIA


Account No : 30055901702 ISFC Code : SBIN0005147
Account Holder Name : ROHITA FALGUN MODH

Bank Branch Name and Address : GOTA AGARWAL MALL

4. Board and Group


Board : GUJARAT SECONDARY AND HIGHER SECONDARY EDUCATION B Group : B

5. Std. XII (HSSCE) Info


Std.XII (HSSCE) Seat No : B-210715

Do you have English Subject in Std. XII(HSSCE) ? YES

Have you appeared in current year GUJCET (2024)?


YES
ચચલલ વરરનન GUJCET આપપલન હહવન જરરન છપ .
GUJCET Seat No. : E515451

6. Details of Examination

Year of Obtained Marks out of Total Marks


Examination Board Attempt
Passing
Obtained Marks Out of Marks

GUJARAT SECONDARY AND


HSSCE 2024 439 700 1
HIGHER SECONDARY EDUCATION
B

7. Details of marks of Science subjects and English obtained Without Gracing in Std.XII (HSSCE)

Particulars MARKS OF XII (HSSCE) Gujcet Gujcet


Marks Total
Theory Practical Marks Total
Subject Obtaine Marks
Obtaine Marks
Marks Out of Marks Out of

CHEMISTRY 60 100 22 50 82 150 22.00 40

PHYSICS 55 100 39 50 94 150 22.00 40

BIOLOGY 78 100 39 50 117 150 33.75 40

ENGLISH 58 100 0 0 58 100 0.00 0

Total 251 400 100 150 351 550 77.75 120


8. Applicant's Contact Details

8.1 Correspondence Address

Address : A 701 gota Ahmedabad Village/City : Ahmedabad

Taluka : Daskroi District : Ahmedabad

State : Gujarat Pincode : 382481

8.2 Contact Info

Mobile : 9879611204 Alternate Mobile No. : 9879611025 Email : devmodh10@yahoo.in

9. Applicant's Personal Details

Gender : MALE Image:


Date of Birth : 07/10/2006
Blood Group : A+

Nationality : INDIAN

Are you Parsi ? : NO


Are you Ex-Service man/Defence Personnel ? : NO
Are you Domicile of Gujarat ? (ગલજરચત નચ રહપવચસન છહ ?) : YES
Category : GENERAL
Are you Persons With Disabilities (PwD)? :NO

10.

(a)Have you participated at the International level Games/Competitions organized by Authorized Organization of Sport
Authority of india ? : NO
(b)Have you participated at the National level Games/Competitions organized by Authorized Organization of Sport Authority
of State ? : No
(c)Have you participated at the State level Games/Competitions organized by Authorized Organization of Sport Authority of
District ? : No
(d)Do you belong to farming community ? (શલ તમપ ખપડલત પરરવચરનચ છહ) ? : YES
(d.1)Date of certificate of 7-12/8-A (૭-૧૨/૮-અ નચ દચખલચનન તચરનખ) : 30/06/2024
(e)Have you passed standard XII examination with Agriculture subjects ? : NO
11. Offline Counselling Centre

Anand Agricultural University, Anand

12.

* ઓનલચઈન ફહમર ભરચર બચદ અપલહડ કરપલ અસલ પમચણપતહ સચથપ ફહમરનન ખરચઈ/ચકચસણન પણ ઓનલચઈન કરવચમચમ આવશપ.
* આ બચબતનહ મપસપજ જપ તપ વવદચથરએ ફહમરમચમ દશચરવપલ ઈમપલ/ફહન નમબર ઉપર મપસપજ આવન જશપ.
Declaration
I have gone through the entire Infomation Booklet for degree programmes along with all terms
and conditions mentioned in it. I have clearly understood the provision of forfeiting of fees and
conditions of cancellation for the candidature of admission as mentioned in Information Booklet.

I hereby confirm that the information given/submitted by me through this online application is
complete and true to the best of my knowledge and that I have made this application with the consent
and approval of my parents/guardian. In the event of my being admitted to the constituent college of
universities I undertake to abide by the disciplinary rules and regulations of the concerned university. I
also undertake to abide by the regulations regarding course curriculum and academic standards as may
be prescribed by the university from time to time.

Candidate's Sign

13. Document List

1.School leaving Certificate/ Birth Certificate


2.Marksheet-1
3.GUJCET Marksheet
4.Applicant's Photo
5.Applicant's Signature
6.7-12/8-A Certificate
7.Pedhinamu / Certificate of Competent Authority
8.Bank Passbook
14. Verification Details

I. હપલપ સપનનર દવચરચ ઓનલચઇન ચકચસણન કરવચમચ આવપલ મચવહતન મમ જતપ પણ સમપપણર પણપ ચકચસણન કરપલ છપ . એ અમગપ નન બચહમધરન આપલમ છલ મ

Candidate's Sign

Verified By : Dr.Bhumikaben Tandel

Verified Date : 01/07/2024 - 10:54AM

Verified IP : 172.110.58.36

College Choice List

College Choice
College Name Subject
Code Order No.

016 1 ASPEE College of Horticulture, NAU, Navsari B.Sc. (Hons.) Horticulture

014 2 College of Horticulture, AAU, Anand B.Sc. (Hons.) Horticulture

004 3 B. A. College of Agriculture, AAU, Anand B.Sc. (Hons.) Agriculture

007 4 N. M. College of Agriculture, NAU, Navsari B.Sc. (Hons.) Agriculture

010 5 CP College of Agriculture, SDAU, Sardarkrushinagar B.Sc. (Hons.) Agriculture

017 6 ASPEE Shakilam Biotechnology Institute, NAU, Surat. B.Tech. (Bio Technology)
Confidential Details

Following details will be used to modify and print from again.

Application ID : UGGSAUCA-B-01-24-9656
Birth Date : 07/10/2006

Challan No : 2400014387
Secret Key : K9Yym31G

વવશપર ખલબ અગતરનલ


* ઓનલચઈન ફહમર વપરરરફકપશન થરચ બચદ વવદચથરએ ફહમરમચમ દશચરવપલ ઈમપલ/ફહન નમબર ઉપર મપસપજ આવન જશપ તરચરબચદ વવદચથરએ કહલપજનન ચહઈસ રફલલગ
કરવન ફરવજરચત છપ .
* કહલપજ ચહઈસ રફલલગ કરચર બચદ કહલપજ ચહઈસ લહક કરવન ફરવજરચત છપ .
* જપ વવદચથરઓએ ચહઈસ રફલલગ કરપલ નહહ હહર તપઓનલમ નચમ મપરનન લનસનમચમ સચમપલ કરવચમચમ આવશપ નહહ.

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