Submitted On: 07/08/2025 14:20 FormNo:9001609
Dombivli Shikshan Prasarak Mandal's
K V Pendharkar College of Arts, Science
and Commerce (Autonomous)
ADMISSION FORM
XI Commerce (2025-2026)
The Principal,
K V Pendharkar College of Arts, Science
and Commerce (Autonomous)
Opposite MIDC Office, Dombivli (E), Maharashtra - 421203.
I wish to apply for admission to the XI Commerce Class. I give below the necessary particulars.
Student Name Prajapati Khushi Manoj
Mother`s Name Phoolkumariprajapati
XI Board Form Number 9001609 Aadhar Card 439664815770
Name As Per Aadhar Khushi kumari DOB As Per Aadhar 06/08/2009
Contact As Per Aadhar 7705953268 Height of the Student (in cm) 140
Weight of the Student 40 ABCI ID / APAAR ID 439664815770
Gender/Sex Female Marital Status Unmarried
Blood Group B+ Date Of Birth(As per LC) 25/09/2007
Place Of Birth (Village/City) Tikari kala Place Of Birth (Taluka) Pindra
Place Of Birth (District) Varanasi Place Of Birth (State) Uttar Pradesh
Place Of Birth (Country) India Nationality Indian
Mother Tongue Hindi Religion Hindu
Category OBC Caste Other backward class
Physically Challenged N/A Inhouse Quota No
Correspondence Address Matoshree sadan building A wing room no 202
(Actual Place Of Stay)
Correspondence Pin Code 400612
Permanent Address Mumbra devi colony road diva east
Native District Thane Native State Maharashtra
Rural/Urban(Native) Rural Mother Mobile no. 8652330198
Student Mobile No 7705953268 Student WhatsApp No 7705953268
Student Email ID mp0681125@gmail.com Father/Guardian Mobile no. 7045919878
Guardian Email ID 07aman8773@gmail.com Avail Railway Concession: Yes
From Station Diva Enrolled in Voter`s List? Yes
Subjects Offered
1. ENGLISH 2. ORGANIZATION OF COMMERCE
3. BOOK KEEPING & ACCOUNTANCY 4. ECONOMICS
5. HEALTH AND PHYSICAL EDUCATION 6. ENVIRONMENTAL EDUCATION
7. MATHEMATICS 8. HINDI
FormNo:9001609
Examination Name of the Board / Mon. & Year Name of the College Seat No Total Marks Attempt Out of /
University of Passing /SGPA Grade
SSC Maharashtra State Board 2025-05 K.V. Pendharkar College A049484 377 1 500
PARENT / GUARDIAN DETAILS
Parents/Guardian Name Manoj Prajapati Parents/Guardian Relationship Daughter
Parents/Guardian Occupation Self employed Parents/Guardian Office Add. Maurya apt
Annual Income (In Figures) 250000.00
DECLARATION BY STUDENT
1. I declare that I will not confirm my admission to any other college before cancelling the admission from this college.
2. I will submit all my original documents to college. I am aware that if information in my admission form is found incorrect / If I submit my original documents in
another college my admission will be treated as cancelled.
3. I declare that all the information I have given in this application is true, correct and complete, and is not false or misleading. I understand giving false ormisleading
information is a serious offence.
4. I declare that the signature on this form is my signature and has not been signed on my behalf by another person.
5. I agree to inform College immediately if there is any change in the information I have given in this application.
6. I understand the College reserves the right to vary or reverse any decision made on the basis of incorrect, incomplete, false or misleading information which I may
have provided, including in some circumstances, termination of my enrollment.
7. I declare that I have not been excluded or subject to disciplinary action at any institution.
8. I understand that the College may obtain official records from any educational institution I have previously attended or my employer.
9. I am aware that any incorrect information given in the application may result in a rejection of my application at the institution’s discretion.
10. I am aware that I must provide the College with the supporting documentation of my application via online application platform. Failure to do so may result in a
rejection of application.
11. I am aware that hard copies should be submitted at college as and when notified by the administration of the College. Any documents submitted if found altered,
forged or tampered with, the college reserves the right to cancel the application without notice to the applicant.
12. I am aware that admission given on the basis of the scanned documents uploaded by the candidate will be provisional and will be confirmed only after the physical
submission and verification of documents with the original ones by competent authorities.
13. I know that Second Language Selection at SYJC has to be same as per the subject selection in FYJC (for Junior College).
14. I know that the Information Technology Subject will be given purely on selection of Subject (IT) & merit at College level (for Junior College).
15. I know that to opt Mathematics subject for Commerce, marks in the SSC examination should be more than 70% (for Junior College).
16. I am aware that 75% attendance is compulsory in both terms.
17. Subjects will be offered as per NEP-2020.
18. Admission fees structure may change due to offered courses as per NEP-2020.
DECLARATION BY PARENT / GUARDIAN
1. I ,hereby fully endorse the above undertaking/declaration given by my child/ward. And I will endeavor to induce my child/ward to do his/her best to observe the
above stated undertaking in words and spirit.
2. Subjects will be offered as per NEP-2020.
3. Admission fees structure may change due to offered courses as per NEP-2020.
(Signature of the Student) (Name & Signature of the Parent / Guardian)
FOR COLLEGE USE ONLY
Remarks:
VERIFIED BY PRINCIPAL
(Name & Signature) (Name & Signature)
Date Amount Receipt No.:
(Receiver Signature)
