10/19/2024
For Office Use
Batch: Scrutiny Payment: Online/DD PI
Only Serial:
Shree L. R. Tiwari College of Engineering (890)
Application No :
University of Mumbai 520428
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
Academic Year: 2024-2025
Regular
APPLICATION FORM
Course Applied for : B.E.(with Credits) - Regular - CBCS - Information PRN:2023016402233762
Technology - S.E. C-Scheme Sem III (BECBCS1001)
Application Date : 19/10/2024 Payment Category : 25
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed on NAZARETH SANAL SIMON
Mark sheet : [*This name will appear on all University records/documents]
Father's/Husband's Name : SIMON Mother's Name : RAINA
Marital Status : UnMarried Mother Tongue :
Place Of Birth : Udupi Gender : Male Date of Birth (DD/MM/YYYY) : 03/08/2005
Blood Group : Religion : Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Thane Tehsil : Thane City/Town/Village :
Available
Address (House
Giriraj Tower , B-307 Sai Baba Nagar Mira Road (E) Pin Code : 401107
no,street/area/suburb etc.) :
Contact details
Mobile Number 917715063971 Email ID: sanalnaz803@gmail.com
2.Legal Reservation Information
Category Type : Open Category : GEN
Is Guardian from EBC (Economic Backward
Is Specially Abled? No
Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem III
ITC301 - Engineering Mathematics-III ITC302 - Data Structure and Analysis
ITC303 - Database Management System ITC304 - Principle of Communication
ITC305 - Paradigms and Computer Programming Fundamentals ITL301 - Data Structure Lab
ITL302 - SQL Lab ITL303 - Computer programming Paradigms Lab
ITL304 - Java Lab (SBL) ITM301 - Mini Project – 1 A for Front end /backend Application using
JAVA
Sem IV
ITC401 - Engineering Mathematics-IV ITC402 - Computer Network and Network Design
ITC403 - Operating System ITC404 - Automata Theory
ITC405 - Computer Organization and Architecture ITL401 - Network Lab
ITL402 - Unix Lab ITL403 - Microprocessor Lab
ITL404 - Python Lab (SBL) ITM401 - Mini Project – 1 B for Python based automation projects
Medium of Instruction : English
4.Guardian Information
Occupation of Guardian : Business Annual Income of Guardian : 0
5.Educational Details
Month and Exam
Name of Name of Board/University and State of Name of Certificate Mark
Year of Seat Out of CGPA %
Examination University School/College No. Obtained
Passing No.
1/2
10/19/2024
Month and Exam
Name of Name of Board/University and State of Name of Certificate Mark
Year of Seat Out of CGPA %
Examination University School/College No. Obtained
Passing No.
MAHARASHTRA STATE BOARD OF
Std 10th SECONDARY AND HIGHER SECONDARY March 2021 -- -- 435.00 500.00 -- - -- 87.00
EDUCATION,
Std 12th MAHARASHTRA STATE BOARD OF
12Th SECONDARY AND HIGHER SECONDARY March 2023 -- -- 346.00 600.00 -- - -- 57.67
(Science) EDUCATION,
Your Last Qualifying Exam:
7.Other Information
Would you like to apply for Hostel accommodation required NA
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 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 )
Document printed on Sat Oct 19 2024 15:51:58 GMT+0530 (India Standard Time)
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