DIRECTORATE OF TECHNICAL EDUCATION

3, MAHAPALIKA MARG, POST BOX NO. 1967, MUMBAI - 400 001

Application Form for Rajarshi Chhatrapati Shahu Maharaj Shikshan Shulk Shishyavrutti Yojana for the
Academic Year 2017-18
Application ID : DSE15198189    Version No : 4    MahaDBT Application No : POSSV022170000810633
Personal Details
Candidate Name VAIDYA SUYASH VILAS
Gender Male
DOB (DD/MM/YYYY) 09/06/1996
Candidature Type Maharashtra - Type A
Category OPEN
Mother Tongue Marathi
Religion Hindu
Region Pune
ganesh nager,chordiya chawl,chinchwad,pune-411033
Permanent Address
Taluka - Haveli District - Pune State - Maharashtra PIN - 411033
Mobile No 9762554272 E-Mail ID suyash.vaidya90@gmail.com
Admission Details
Admission Year 2015
Program Type Direct Second Year Degree in Engineering-Technology
Institute Name 6185 - Sinhagad Institute of Technology, Lonavala
Course Name Electronics and Telecommunication Engg[Second Shift]
Choice Code 618537220 Seat Type CAP
Admission Date 10/08/2015 Reporting Date 10/08/2015
CAP Round 1 CAP Merit No 29912
Other Personal Details
Father's Name vilas Mother's Name anjali
Guardian's Name vilas Guardian's Native Place chinchwad
Candidate's Birth Placemumbai SSC Roll Number C057750
Current Studying Year Final Year PRN / Enrollment Number 71640196H
Name of School / Institute Last Attended PAD.DR.D.Y Patil Polytechnic Akurdi
D. Y. Patil Educational Complex, Sector 29, Nigdi Pradhikaran,, Akurdi, Pune,
Address of School / Institute Last Attended
Maharashtra 411044
Applied For Any Other Scholarship / Concessions None
Child Number 1
Aadhaar Number 256155028761 (Aadhaar Number Verification Incomplete)
Candidate’s Name (As Per Aadhaar Record) SUYASH VILAS VAIDYA
Family Income Details (For Financial Year 2016-17)
Total Family Income (Including Both Parents) Rs . 90,000/-
Income Certificate Issuing Authority Tahsildar
Income Certificate Number 41935017291
Income Certificate Issue Date 29/06/2017
Candidate's Bank Details
Candidate’s Name (As Per Bank Record) SUYASH VILAS VAIDYA
Bank Name Bank of Maharashtra
Branch Name CHINCHWAD
Account Number 68018205674 IFSC Code MAHB0000127
MICR Code 411014046 Account Seeded with Aadhaar Yes
Qualification List (Starting from SSC till Last Exam Passed)

Qualification Year of Study Result Passing Month & Year Marks Marks
Type
SSC SSC Distinction June, 2012 Percentage 452.00/550.00 (82.18)
Diploma Diploma First Class June, 2015 Percentage 1200.00/1700.00 (70.59)
Direct Second Year Degree in Engineering- Second Year Second Class January, 2016 Percentage 791.00/1500.00 (52.73)
Technology
Direct Second Year Degree in Engineering- Third Year Second Class January, 2017 Percentage 792.00/1500.00 (52.80)
Technology
Exam Fee / Tution Fee Details
Odd Semester Exam Fee Rs . 1,330/- Even Semester Exam Fee Rs . 1,555/-
Tution Fee Rs . 88,246/- Total DBT Amount Rs . 45,566/-
List of Documents Required
Sr. No. Document Name
1. Family Income Certificate of Financial Year 2016-17 issued by Tahsildar / Sub Divisional Officer / Deputy Collector / Collector of the
District / Metropolitan Magistrate.
2. Domicile Certificate of Maharashtra / Maharashtra Karnataka Border.
3. Statement of Marks of Last Year attested by the Principal. (If Applicable)
4. GAP Affidavit. (If Applicable)
5. Death Certificate of Father, If Not Alive. (If Applicable)
6. Aadhaar Card.
7. Bank Passbook Front Page Copy / Cancelled Cheque.
8. Leaving Certificate.
 9. CAP Admission Allotment Letter.
Declaration
           The above information given by me for Rajarshi Chhatrapati Shahu Maharaj Shikshan Shulk Shishyavrutti Yojana as a parent is true to the best of
my knowledge & belief. If at later stage, it is found that I have furnished wrong information and /or submitted false certificates, I am aware that my
sons/daughters admission stands cancelled.
                    I am aware that if my family income is found above the limit fixed by the Authority, I will have to pay two fold of amount sanctioned by the
Authority. The authority may recover the amount from me, from my heritor or as dues on land revenue in case of not returning the amount.

Place : Date :

Printed On : 3/3/2018 12:29:15 PM Father/Mothers/Guardian Signature Candidate Signature

Last Modified On : 3/3/2018 12:29:10 PM (VAIDYA SUYASH VILAS)