Reference No Form No Level Name Course Name Category

101691 POST GRADUATE MCOM (B&F) OPEN

First Name : VARSHA DEVI Address : ROOM NO. 375, SHAHID BHAGAT SINGH NAGAR, KUMBHARWADA, SION

Middle Name : JAYPRAKASH Pin Code : 400019

Surname : SINGH

Mother Name : MANJU DEVI

Nationality : INDIAN Phone(with STD): - Mobile: 7715905958

Date of Birth : 10/9/1993 Email ID : singhvarsha143341@gmail.com Gender: FEMALE

Native Place : UP Native Address : UP

Father's Name: JAYPRAKASH SINGH Mother's Name : MANJU DEVI

Occupation : BUSINESS Occupation :

Office Address: Office Address :

Phone No. : Phone No. :

Email ID : Email ID :

Moblie No. : 9967532778 Moblie No. :

Annual Income: 144000 Annual Income :

GuardianName: Phone No. :

Relation : Email ID :

Occupation : Moblie No. :

Office Address:

12th PCM : Phy - / Chem - / Maths - /

Entrance Exam: / Merit Score :

Education Board Year of Passing % Marks or CGPA Class Specialization

SSC MAHARASHTRA 2010 61.20% A NA

HSC MAHARASHTRA 2012 54.50% B COMMERCE

GRADUATION MUMBAI 2015 62.16% A BAF

Place : Mumbai Date : 25-Aug-2015 ____________________ _____________________

Signature of the Applicant Signature of Parent/Guardian

*101691*

Declaration ( to be signed by applicant and Parent / Local Guardian )

1) I shall abide by all the rules and regulations of the Mumbai University and Govt. of Maharashtra and the Institute.2) I shall be regular in attending all lectures, tutorials, tests, practicals, workshop and examinations conducted.3) I was not debarred from appearing for any examination conducted either by any Government Constituted or any other Statutory Examination Authority in India.4) I shall pay fees and other charges by the due date. If the fee structure is revised, the difference in fees will paid accordingly. In event of default, the Principal of the Institute may take any action as he might deem fit.5) I shall pay fees for complete duration of the course before collecting Leaving/ Trasnfer Certificate.6) All the information provided in the form is true.

APPLICATION FORM