Dr. D. Y.
Patil Unitech Society's
Dr. D. Y. Patil Arts, Commerce & Science Junior College
Pimpri, Pune - 411018
Affiliated to Savitribai Phule Pune University (ID.NO PU/PN/ACS/111/1995)
Phone:020-27423595 FAX: (020) 27420711, Email:info.acs@dypvp.edu.in
UDISE No 27252001901 INDEX No J 11.16.018
APPLICATION FORM FOR ADMISSION
Admission for the Course F.Y.J.C.(Commerce with IT) Year 2023-24
Application No :83023 School UDSIE No :11.16.159
Candidate's Name : Shaikh Shifa Nasir Mother's Name : Noorjaha
Name As Per Aadhar : Shifa Nasir
Shaikh
Date of Birth
Mobile No :9209190020 Blood Group :B+
:11/02/2007
Place of Birth :Bhosri Gender :Female Organ Donation :No
Marital Status Signature of the
Email ID :shifa.n.shaih2007@gmail.com Nationality :Indian Candidate
:UnMarried
Aadhar No
Caste :OPEN Religion :Muslim
:456595245958
Local Address :Falt no B201, Green spirit society, near PCMCschool, Thergaon
Permanent Address :Falt no B201, Green spirit society, near PCMCschool, Thergaon
Taluka :Mulshi District :Pune
Mother Tongue :hindi Rural/Urban :Urban
INFORMATION OF THE PARENT'S / GUARDIAN
Parent's Name :Nasir Shaikh
Address :Falt no B201, Green spirit society, near PCMCschool, Thergaon
Cell No :8421835641 Email ID :
Occupation :self employe Central Govt. Employee :No
Relation :daughter Annual Income :500000
ACADEMIC INFORMATION (PREVIOUS EXAMINATION PASSED)
Examination Board Year of Center & Seat Obtained/Total Percentage School/College from Which
Passed : Name : Passing : No : Marks : : Passed :
10th SSC Mar/2023 Co79289 277 55.40 Baby's English high school
SUBJECT OF CHOICE
1-ENGLISH-XI
30-PHYSICAL EDUCATION-XI
31-EVS-XI
4-HINDI-XI
49-ECONOMICS-XI
50-ACCOUNTS
51-ORGANIZATION OF COMMERCE AND MGMT -XI
99-INFORMATION TECHNOLOGY-XI
Place : Date : 26-07-2023
Signature of the Candidate
UNDERTAKING
I will not carry or contain with me any hazardous or dangerous article which may use as a
weapon or the use of which may adversely affect the life or limb of any other person.
I will not go in any other building other than junior college building .I will be responsible for
my safety.
I have no physical problem. In case of any health issue I will inform the class teacher.If any
health problem arises in the college, class teacher should wait till parents come/ should
take him/her to the hospital.
As per norms of H.S.C board I give the consent that EVS I will complete Project
/Assignment & submit EVS and PT project & other assignment work within time.
I declare that I have read all the rules of admission as contained in the prospectus of the
college. I understand and bind myself to these rules. I understand and accept that my
admission will be provisional and subject to verification of all documents as mentioned in
the prospectus.
The information given by me in my application is true to the best of my knowledge and
belief & if it found incorrect at any moment of time during two years my admission stand
cancel and for that I myself will be responsible.
I undertake and bind myself to pay tuition fees and other fees, by the due date which the
college may levy from time to time and in the event of failure the Principal of the college
may take such action against me.
If in case any above rule is void the management has full authority to take necessary action
including expulsion of my son/daughter from college.
I know smart mobile phone & other smart Electronic gazettes are not allowed in the
campus.
Signature of the Candidate: Signature of the Parent's/Guardian
