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Application Form: Student SSC Details

This application form provides details about Sanjay Barkya Zirva who is applying for admission to a Master of Arts program in Chemistry at Ismail Yusuf College for the 2015-2016 academic year. The summary includes that Sanjay completed his Bachelor of Science in 2015 from N.B. Mehta Science College, earning 70% marks. He is a Scheduled Tribe male from Maharashtra with a UID number and annual family income of Rs. 34,000. He currently resides and studies at a boys hostel in Goregaon, Mumbai while seeking admission and scholarship. Required documents like caste, income, and mark sheets are attached for verification.

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SudamMerya
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110 views3 pages

Application Form: Student SSC Details

This application form provides details about Sanjay Barkya Zirva who is applying for admission to a Master of Arts program in Chemistry at Ismail Yusuf College for the 2015-2016 academic year. The summary includes that Sanjay completed his Bachelor of Science in 2015 from N.B. Mehta Science College, earning 70% marks. He is a Scheduled Tribe male from Maharashtra with a UID number and annual family income of Rs. 34,000. He currently resides and studies at a boys hostel in Goregaon, Mumbai while seeking admission and scholarship. Required documents like caste, income, and mark sheets are attached for verification.

Uploaded by

SudamMerya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application Form

Application Number

APPSANJAYZIRVA2015

Appilcation type

New

Please Paste
Passport Size
Photograph
Renewal Course Year N.A

Student SSC Details


SSC Board

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION

Passing Year

2010

SSC Seat No

E102715

SSC Marks Obtained

77.00

Applicant's Details
291528994413

UID Number

Applicant Name SANJAY

Date of Birth

UID Enrollment Number


BARKYA

ZIRVA

first name

middle name

30-11-1993

Gender

last name

1127/50108/00339 14/04/2012
11:48:24
Mother's CHANGUNA
Name
BARKYA ZIRVA

Is Resident of Maharashtra Yes

Male

Academic Year 2015-2016

Application Date 30-09-2015

Caste Category Scheduled Tribe


Caste

Warli

Sub Caste

Orphan

No

Is Disabled

Is Applicant
Salaried ?

No

Maritial Status

No

N.A

No

Disability Type

N.A.

Applicant's
0.00
Annual Income

Total Annual
Income

34000.00

Is Staying at
Hostel ?

Has Applied For No


Hostel ?

Yes

Student Prequalifying Details


Last attended School/College/Institute
Last Exam Passed
Passed

GOKHALE EDUCATION SOCIETY'S N.B.MEHTA SCIENCE COLLEGE,


BORDI
Bachelor of Science
Last Exam Passed
2015
Last Exam 70
(General) TYBSc
Year
Marks
Yes

Institution Details
Name of School/College/Institute
where Admitted

Principal,Ismail Yusuf College of Arts,Science & Commerce,Jogeshwari,Mum-

Course Name

Master of Arts (Chemistry)

Subject

N.A

Academic Year

2015-2016
07-09-2015

College Admission 2445298


Number

Date Of
Admission

27-08-2015

Joining Date

Is Fees Paid ?

No

Fee Paid

0.00

Fee Receipt No.

Fee Receipt Date

N.A

Course Year 1

GrantType

Granted

Is Admission after Diploma

Quota

N.A
Government
Quota

No

Contact Details
1 Of 3

Residential Number: N.A, MobileNumber: 9273829079, EmailAddress: akshayraut07@gmail.com


Address For Correspondence
Address:- OSARVIRA
District:- Thane

Location:- OSARVIRA

City:- OSARVIRA

Pincode:- 401602

Taluka:-

Parent / Guardian Details


Parent's name

BARKYA

SAKYA

first name

middle name

Relation with Applicant Father


Parmanent Address

Parent Age

ZIRVA
last name

57(yrs)

Profession

Agricultural, fishery
and related labour
Parents Annual 34000.00
Income

OSARVIRA, ta dahanu

Hostel Information
Name of Landlord /
Hostel
Hostel Type

GAUTAM GOVERNMENT BOYS HOSTEL


GOREGAON

Tribal Department

Is Mess Service Available?

Hostel/ Landlord Address:- 2/28 NEW SHASTRI NAGAR


Address
NERAR SIDDHARTH HOSTPITAL GOREGAON
WEST Location:- GOREGAON City:GOREGAON Pincode:- 400104 District:Mumbai(Suburban)

Is Studying in night school

No

Hostel Admission
Date

07-09-2015

Rent Per Month

N.A

Hostel/Landlord
Contact Details

Residential
Number: -,
MobileNumb
er:
8976841389,
EmailAddres
s:

No

Document Details
Caste Certificate ADM/ST/SRNo
894/2010

District Issuing
Office

Thane

Taluka Issuing
Office

Dahanu

Caste Validity
Certificate No

N.A

District Issuing
Office

Thane

Scrutiny
Committee No

N.A

Income
Certificate No

SR NO 133

Issued in

2015

University
Registration No

N.A

Student Bank Account Details


Bank Name

CORPORATION BANK

Branch Name

MUMBAI - AMBOLI

IFSC Code

CORP0000432

Bank
Account No

043200101036896

MICR Code

400017026

Document Attached
Caste Certificate Issued by Competant Officer
Income Proof - Income Certificate Issued by Competant Authority
Marksheets
I-card Size Photo
Caste Validity Certificate
SSC Mark Sheet
UID Number

2 Of 3

Declaration
The information furnished by me is complete and correct. I bear the complete responsibility for all the above
information.
Applicant's Signature

_______________________

Principal's Signature

_______________________

Applicant Parent's Signature

_______________________

3 Of 3

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