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Batch:                       Scrutiny                        Payment: Online/DD        PI
               yl n O     Serial:
                        Suman Educational Trusts Dilkap Research Institute of Engineering and Management Studies (857)
                                                                                                                         Application No :
                                                             University of Mumbai
                                                M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
                                                                                                                              600945
                                                            Academic Year: 2024-2025                                          Regular
                                                             APPLICATION FORM
Course Applied for : B.E.(with Credits) - Regular - CBCS - Computer                                                     PRN:2021016402118136
Engineering - T.E. C-Scheme Sem V (BECBCS1001)
Application Date : 07/05/2025 Payment Category : 25
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed CHAWAN ROHAN PARSHURAM
on Mark sheet :                  [*This name will appear on all University records/documents]
                                                   Mother's
Father's/Husband's Name :        PARSHURAM
                                                   Name :          SANGEETA
                                                   Mother
Marital Status :                 UnMarried
                                                   Tongue :
Place Of Birth : Kalwa THANE            Gender : Male          Date of Birth (DD/MM/YYYY) : 08/06/2003
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
no,street/area/suburb ROOM NO. 133 PARSHURAM CHAWAN SAMRAT ASHOK NAGAR ROAD          Pin Code : 400605
                        KALWA {E}
etc.) :
Contact details
Mobile
Number          8691960906                                       Email ID: chawanrohan2873@gmil.com
2.Legal Reservation Information
Category Type :
Open
                    Category : GEN
                                        Is Guardian from EBC (Economic
Is Specially Abled? No                  Backward Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
  Sem V
  CSC501 - Theoretical Computer Science                                       CSC502 - Software Engineering
  CSC503 - Computer Network                                                   CSC504 - Data Warehousing & Mining
  CSL501 - Software Engineering Lab                                           CSL502 - Computer Network Lab
  CSL503 - Data Warehousing & Mining Lab                                      CSL504 - Professional Comm. & Ethics II
  CSM501 - Mini Project : 2A                                                  CSDLO5012 - Internet Programming
  Sem VI
        CSDLO6011 - Internet of Things                                           CSC601 - System Programming and Compiler Construction
        CSC602 - Cryptography and System Security                                CSC603 - Mobile Computing
        CSC604 - Artificial Intelligence                                         CSL601 - System Programming & Compiler Construction Lab
        CSL602 - Cryptography & System Security Lab                              CSL603 - Mobile Computing Lab
        CSL604 - Artificial Intelligence Lab                                     CSL605 - Skill base Lab Course: Cloud Computing
          CSM601 - Mini Project 2B
Medium of Instruction : English
4.Guardian Information
Occupation of Guardian : Business                              Annual Income of Guardian : 120000
5.Educational Details
                                                             Month    Exam
   Name of         Name of Board/University    Name of     and Year Seat Certificate  Mark                     Out CGPA         %
 Examination        and State of University School/College of Passing No.   No.      Obtained                   of
                   MAHARASHTRA STATE
                   BOARD OF SECONDARY                           March
Std 10th                                                                    --       --            274.00     500.00 -- - --   54.80
                   AND HIGHER SECONDARY                         2019
                   EDUCATION,
                   MAHARASHTRA STATE
Std 12th 12Th      BOARD OF SECONDARY
                                                                June 2021   --       --            330.00     600.00 -- - --   55.00
(Science)          AND HIGHER SECONDARY
                   EDUCATION,
                MAHARASHTRA STATE
Certificate :   BOARD OF SECONDARY
                                                                June 2021   --       --            330.00     600.00 -- - --   55.00
HSC Certificate AND HIGHER 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 Wed May 07 2025 16:08:10 GMT+0530 (India Standard Time)