STUDENT COPY
LATE KRISHNARAO RAMJI PATIL JUNIOR COLLEGE, KHAMGAON, BULDHANA (13113)
Yashwantrao Chavan Maharashtra Open University Application No :
Dnyangangotri Near Gangapur Dam, Nashik, Pin Code-422222, Maharashtra(India)
Academic Year: 2020-2021
437354
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.(with Credits) - Distance Education - 2000 Pattern - S.Y.B.A. (G01) PRN:2019017000773282
Application Date : 11/09/2020 Payment Category : 8
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
HIWRALE PRAMOD RAJU
Candidate's Name as printed on
[*This name will appear on all University
School leaving/Passing Certificate :
records/documents]
Father's/Husband's Name : RAJU HIWRALE Mother's Name : REKHA
Marital Status : UnMarried Mother Tongue :
Place Of Birth : Gender : Male Date of Birth (DD/MM/YYYY) : 17/08/1997
Blood Group : Religion : 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 :
Location Area : Not
State : Maharashtra District : Buldhana Tehsil : Khamgaon City/Town/Village :
Available
Address (House
no,street/area/suburb NO1 AT AMBIKAPUR POST CHITODA AT AMBIKAPUR POST CHITODA Pin Code : 444303
etc.) :
Contact details
Mobile
917767979816 Primary Email ID: pramod17@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : SC
Reserved
Is Specially Abled? No
3.Social Information(Additional Inforamtion)
Paper Selected for:
S.Y.B.A.
MAR210 - Vangmayprakarancha Aabhyas MAR211 - Swatantryottar Vangamayen Pravah
HIS220 - Aadhunik Bharatcha Itihas HIS221 - Aadhunik Jagacha Itihas
SOC222 - Samajik Parivartan Aani Samajik Chalvali SOC223 - Bharatiya Samaj
EVS201 - Enviorment Studies
T.Y. B.A.
Medium of Instruction : Marathi
Admission Fee Payment Fee Category : Regular Fees Over All Payment Status: : Paid
Details
Adm Exam Fee - 750 Tution Fee - 400
Registration Fee - 100 Development Fund Fee - 150
Other Fee - 200 Total : 1600
Payment
Installment Amount Transaction Date Transaction Number Transaction Type
Status
1 1600 Paid 11/09/2020 04:08:58 3425161599840538859 Online Payment
4.Guardian Information
Occupation of Guardian : Farmer Annual Income of Guardian : 30000
5.Educational Details
Month and Exam
Name of Name of Board/University and Name of Certificate Mark Out
Year of Seat CGPA %
Examination State of University School/College No. Obtained Of
Passing No.
MAHARASHTRA STATE BOARD
Std 12th 12Th February
OF SECONDARY AND HIGHER -- -- 366.00 650.00 -- - -- 56.31
(Science) 2015
SECONDARY 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 )
[STUDY CENTER COPY]
LATE KRISHNARAO RAMJI PATIL JUNIOR COLLEGE, KHAMGAON, BULDHANA (13113)
Yashwantrao Chavan Maharashtra Open University
Application No :
Dnyangangotri Near Gangapur Dam, Nashik, Pin Code-422222, Maharashtra(India)
Academic Year: 2020-2021
437354
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.(with Credits) - Distance Education - 2000 Pattern - S.Y.B.A. (G01) PRN:2019017000773282
Application Date : 11/09/2020 Payment Category : 8
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
HIWRALE PRAMOD RAJU
Candidate's Name as printed on
[*This name will appear on all University
School leaving/Passing Certificate :
records/documents]
Father's/Husband's Name : RAJU HIWRALE Mother's Name : REKHA
Marital Status : UnMarried Mother Tongue :
Place Of Birth : Gender : Male Date of Birth (DD/MM/YYYY) : 17/08/1997
Blood Group : Religion : 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 :
Location Area : Not
State : Maharashtra District : Buldhana Tehsil : Khamgaon City/Town/Village :
Available
Address (House
no,street/area/suburb NO1 AT AMBIKAPUR POST CHITODA AT AMBIKAPUR POST CHITODA Pin Code : 444303
etc.) :
Contact details
Mobile
917767979816 Primary Email ID: pramod17@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : SC
Reserved
Is Specially Abled? No
3.Social Information(Additional Inforamtion)
Paper Selected for:
S.Y.B.A.
MAR210 - Vangmayprakarancha Aabhyas MAR211 - Swatantryottar Vangamayen Pravah
HIS220 - Aadhunik Bharatcha Itihas HIS221 - Aadhunik Jagacha Itihas
SOC222 - Samajik Parivartan Aani Samajik Chalvali SOC223 - Bharatiya Samaj
EVS201 - Enviorment Studies
T.Y. B.A.
Medium of Instruction : Marathi
Admission Fee Payment Fee Category : Regular Fees Over All Payment Status: : Paid
Details
Adm Exam Fee - 750 Tution Fee - 400
Registration Fee - 100 Development Fund Fee - 150
Other Fee - 200 Total : 1600
Payment
Installment Amount Transaction Date Transaction Number Transaction Type
Status
1 1600 Paid 11/09/2020 04:08:58 3425161599840538859 Online Payment
4.Guardian Information
Occupation of Guardian : Farmer Annual Income of Guardian : 30000
5.Educational Details
Month and Exam
Name of Name of Board/University and Name of Certificate Mark Out
Year of Seat CGPA %
Examination State of University School/College No. Obtained Of
Passing No.
MAHARASHTRA STATE BOARD
Std 12th 12Th February
OF SECONDARY AND HIGHER -- -- 366.00 650.00 -- - -- 56.31
(Science) 2015
SECONDARY 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 Fri Sep 11 2020 16:10:38 GMT+0530 (India Standard Time)
