APPLICATION FORM FOR ADMISSION

Form No. : 2019/2235

To be filled in by the Applicant

To,
The Principal,
R.N.C. Arts, J.D.B. Commerce & N.S.C. Science College, Nashik Road

Kindly admit me to the T.Y. B.Sc. Class of your College. I hereby declare that the information given below is correct. I
hereby undertake to abide by the rules & regulations of the college / University. I am seeking admission to the above class at
my own risk and if for some reason or other my admission is cancelled by the University or College authorities at any time, I
shall not hold either University or College responsible for the same.

Date : ____/____/2019 (Signature of the Applicant)

Applicant’s Name: BANSOD SHUBHANKAR CHARUDATT

Surname Name Father’s/Husband’s Name

Name In Devnagri Script :

102 Amit,Shree Gajanan

102 Amit,Shree Gajanan Park,Chehedi
Local Address: Park,Chehedi-Shiv Permanant Address:
Shiv Road,Nashik Road,Nashik.;
Road,Nashik Road,Nashik.
Local Tel.No.: Permanant Tel.No.
Mobile No.: 9763035254 Email ID: shubhankarbansod161515101@gmail.
Gender: Male Blood Group O+
Date of Birth: 22/04/1996 Place of Birth Nashik Road
Taluka & District Nashik, Nashik State Maharastra
Caste Sonar Subcaste
Category: OBC Student Minority None
Religion: Hindu

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Sports Category: No Level of Participation
Physical Diability; No If Yes, Type of Diability
Aadhar No. 841924225623 Voter ID. YLV6903702
Father/Guardian
Name of Father/Guardian: Bansod Charudatt Balasaheb Father
Occupation
102 Amit,Shree Gajanan
Father/Guardian Address; Park,Chehedi-Shiv Father/Guardian Tel.No. 8308599039
Road,Nashik Road,Nashik.
Annual Income of
65000
Father/Guardian
Parent(s) in Millatry Parent(s) State/Central
No No
Services/Ex-Servicemen Govt. Employee

Academic Information

Name of Last Attended

Bytco College Board/University Pune University
College
Month & Year of Passing 06/2019 Seat No. : 21204
No. of Attempt(s)
Total Marks Obtained : 560 Out Of Marks : 1000
Percentage : 56.0 Grade/Class :

Subject Selection

Medium of Instruction :N/a

Special Subject/Subject(s) Selected: Mathematics

Name of the Bank : IDBI Bank

A/c No. : 1912104000025197
IFSC Code : IBKL0001912
MICR Code :

I have read the rules and regulations of the College given in the Prospectus. I have verifed the information stated by my ward
in this application. I declare that the given information is correct. I request the college authorities to admit my ward in the
College. I shall be watchful and responsible about the progress and behaviour of my ward.

Date: Date : ____/____/2019

Place. ____________ (Signature of the Applicant's Parent) (Signature of the Applicant)

For Office Use Only

Form No. : 2019/2235

Enclosed :
True copy of F.Y. / S.Y. Marksheet
True copy of Cast Certificate for B.C. Students only
True Copy of Aadhar Card

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