State Common Entrance Test Cell http://mhtcet2017.dtemaharashtra.gov.in/ack_print.

aspx

Application No. 2017448254

1. Name of the Candidate (As appearing on the SSC (10th)/Equivalent Examination)
Candidate's Full Name BUCHUDE RAHUL SAVKAR
Father's/Husband's First Name SAVKAR
Last Name (Surname) BUCHUDE
Mother's Name MEENAKSHI
2. Gender MALE
3. Date of Birth 26/09/1999
SR. NO 81/1/1, ROAD NO.
B-3,,KRISHANANAGAR,
4. Address for Correspondence
DIGHI,PUNE,PUNE,MAHARASHTRA-
411015 (INDIA)
Mobile No. 9762201818
Registered Email Id satish.thube@gmail.com

5. Permanent Residence is in
Village 6. Are you an Indian National? Yes
a
7. Candidate is Domicile of In Maharashtra
8. Category of Candidate 8(a). I possess Caste
None N.A
(Caste recognised is Maharashtra) Certificate
9. a Do you Belong to Person with Disability (PWD) - N.A
9 b. J & K Migrant - N.A 10. Religion HINDU
11. I have also registered for JEE (Main) 2017 NEET 12. Total Annual Family Income (in ) 1 Lakh to 2.5
2017 Lakh
13. Aadhaar Number (I hereby give consent to use my
807065584187
Aadhaar Number for authentication)
14 a. Name of the Account holder as per Bank Record SATISH THUBE
14 c. Name of the Bank Branch MAGARPATAA
14 b. Name of the Bank ICICI Bank
HADAPSAR PUNE
14 d. Account Type Saving 14 e. Bank Account Number 058101509431
14 f. Bank IFSC Code ICIC0000581

15. Details of HSC (12th) / Equivalent Examination

a. HSC (12th) / Equivalent Exam appeared/passed from School/Jr. College situated In Maharashtra
b. District of School / Jr. College Pune (16)
16. Details required for MHT-CET 2017
a. I wish to appear for the following subject/s in CET Physics,Chemistry,Mathematics,Biology
b. I want to have the question paper in English

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State Common Entrance Test Cell http://mhtcet2017.dtemaharashtra.gov.in/ack_print.aspx

17. Fee Payment Details

a. Transaction b. Date of Transaction 2017-02-21 c. Amount 800.00 (excluding services
Number 191563537 10:12:41 charges)

Declaration

1. I BUCHUDE RAHUL SAVKAR, hereby solemnly and sincerely affirm that each and every information submitted by
me in the online application form is true and correct.
2. I have not concealed any material information, however if any information submitted herein is found fraudulent,
incorrect or untrue, I understand that I am liable to criminal prosecution and I also agree to forgo my seat in
Engineering and Technology, Pharmacy and Pharm. D. degree course(s). I also understand that my selection and
admission to the course is also liable to be cancelled.
3. I have carefully read the rules & regulations of MHT-CET 2017 brochure and I agree to abide by them. I hereby accept
entirely the legality, validity and correctness of these rules. I understand by submitting this application I have accepted
the correctness, validity and/or justifiability of all these rules and regulations and that had I not accepted the
correctness and validity of these rules I would not have submitted this application and further that it will not be open
hereinafter to challenge and / or question validity and / or correctness of any rule or part thereof.
4. I undertake to submit all the required certificates at the time of document verification as well as at the time of
admission to a course/college as per the rules, failing which I understand that my claim for selection shall not be
granted.

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