APPLICATION NO:

LSIMUM20/UGD/1704

Course Details
Course : NKC - BACHELOR DEGREE Specialization : INTEGRATIVE NUTRITION AND DIETETICS
I'm undergoing my Commercial Pilot training. It's been 5-6 years I'm
Why Do You Wish To Enroll For This Course? in fitness. I want to have a degree in which I can pursue a lot of
knowledge in the field I love the most

Personal Details
Name MR OMKAR RAVIESH JITURI
Date of Birth 28/08/2001 Caste KSHATRIYA
Gender MALE Email Address OMKARJITS35@GMAIL.COM
Mobile Number +91-9373000915 Marital Status SINGLE
Blood Group O+ Place of Birth KOLHAPUR
Nationality INDIAN Category OBC
Aadhar Card Number 493538159336 Are You Differently Abled ? NO
Nature Of Deformity Ward Of
Passport Number Passort Country
Place of Issue Date of Issue
Date of Expiry Religion
Language Known HINDI, ENGLISH, MARATHI

Parents Details
Parent / Guardian Details FATHER; MOTHER
Father Mother Guardian
Name MR RAVIESH NARAYAN JITURI MRS HEMLATA RAVIESH JITURI
Mobile No. +91-9823068177 +91-9657728177
Email Address
Occupation BUSINESS OTHER ()
Country - -
State - -
District - -
City - -
Address Line 1 - -
Address Line 2 - -
Pincode - -

Address Details
Is Permanent Address Same As Address For Communication? : YES
Correspondence Permanent
Country INDIA INDIA
State / Province MAHARASHTRA MAHARASHTRA
District KOLHAPUR KOLHAPUR
City KOLHAPUR KOLHAPUR
1505/A PLOT NO. C4 NARAYAN BUNGALOW, 1505/A PLOT NO. C4 NARAYAN BUNGALOW,
Address Line 1
NEW PALACE AREA, KARVIR KOLHAPUR NEW PALACE AREA, KARVIR KOLHAPUR
Address Line 2
Pin Code: 416003 416003

10th Details
Grade
Medium of Year of Group Seat Certificate Marking Percentage
School Name Board /
Instruction Passing Major Number Number Scheme / CGPA
Class
 MAHARASTRA
STATE BOARD
MAHARASHTRA OF SECONDARY
ENGLISH 2017 F096142 PERCENTAGE 81
STATE BOARD AND HIGHER
SECONDARY
EDUCATION

After 10th Qualification : 12TH

12th Details
Grade
Medium of Year of Group Seat Certificate Result Marking Percentage
School Name Board /
Instruction Passing Major Number Number Status Scheme / CGPA
Class
MAHARASTRA
STATE
BOARD OF
MAHARASHTRA
SECONDARY ENGLISH 2019 PCMB X032931 DECLARED PERCENTAGE 57.23 B
STATE BOARD
AND HIGHER
SECONDARY
EDUCATION

Diploma Details
School Medium of Year of Group Seat Certificate Result Marking Percentage / Grade /
Board
Name Instruction Passing Major Number Number Status Scheme CGPA Class

Graduation Details
Graduation Graduation Graduation
State University Institute
Grade
Medium of Year of Group Seat Certificate Result Marking Percentage
Degree Specialization /
Instruction Passing Major Number Number Status Scheme / CGPA
Class

Do You Have Any Academic Achievement? : NO

Association Level Position Year
1
2
3

Upload Documents Details

Upload Your Scanned Copy Of Signature YES
Upload Your 10th Marksheet YES
Upload 10th Certificate NO
Upload Your 12th Marksheet YES
Upload Your 12th Certificate NO
Upload Your Diploma Marksheet NO
Upload Your Graduation All Semester Marksheet NO
Upload Your Provisional Certificate NO
Upload Your Convocation / Degree NO
Upload Your Leaving Certificate NO
Upload Your Migration Certificate NO
Upload Your Transfer certificate NO
Upload Your Bonafide Certificate NO
Upload Your Passport NO
Upload Your Aadhar Card YES
Upload Your PAN Card NO
Upload Your Driving Licence NO
Declaration
I Agree That I Am Required To Use My Best Endeavours To Meet The Requirements Of The Program Selected And To Abide By The Rules And
Regulations Of The
Institute. I Further Agree To Keep Myself Updated And Also To Abide With All Future Amendments Or Changes Made In Academic Guidelines,
Training & Internship
Requirement, Study Center, Examination Center And Other Terms Of Admission, I Understand That If I Breach Any Of The Institute's Rules Or
My Behaviour Is
Deemed Unacceptable By Institute, Including Poor Attendance Or Unsatisfactory Progress, My Admission May Be Cancelled And I Agree That I
Will Not Be Entitled
To Any Refund Of The Tuition Fees Or Other Charges Paid To The Institute.

Applicant Name Parent Name Date Place

OMKAR RAVIESH JITURI RAVIESH NARAYAN JITURI 11/09/2020 KOLHAPUR

Payment Options :
You can make the payment in either of the following methods:

Draw a Demand Draft (DD)/ Cheque in favor of “NAGINDAS KHANDWALA COLLEGE” payable
at our admission desk.
Online Transfer through RTGS / NEFT, details as mentioned below:

Name: Nagindas Khandwala College

Bank Name: HDFC Bank
Bank Branch: Juhu Tara Road, Santacruz West, Mumbai
Account No: 50100297501911
Account Type: Current Account
IFSC Code: HDFC0001800
Note:- In case of payment through RTGS / NEFT, please email us the scanned copy of the RTGS / NEFT confirmation letter from
your bank.