8/14/2021 School Education and Sports Department

Office of the Deputy Director of Education, Mumbai Division

Std. 11th Centralised Online Admission Process 2021-22

शिक्षण उपसंचालक कार्यालय, मुंबई विभाग

इयत्ता ११ वी कें द्रीय ऑनलाइन प्रवेश प्रक्रिया २०२१-२२

Application Form No. : MU1130136

Version No. : 2
Personal Details, Type of Candidature and Board Details of Applicant

Full Name PATIL VAIBHAV ANANTA Mother's Name ARCHANA

Gender Male Date of Birth 31/07/2005

Board SSC Month & Year of Examination March, 2021

Seat No. A061619 Residence Within MMR Area

10th School Name BHAURAO POTE VIDYALAYA, KALYAN (W), THANE

10th School Index Number 16.17.126 10th School UDISE Number 27210600307

Address for Correspondence and Contact Details

JAYESH BHOIR CH. ROOM NO.1,CHAWL NO.1,GAURIPADA ROAD SUBHAM COMPLEX OPP KALYAN(W), KALYAN, KALYAN, Thane,
Correspondence Address
Maharashtra, 421301

Mobile No. 8591079171, 9082391002 Phone No. 9220871879

E-Mail ID vaibhav4497patil@gmail.com

Reservation Details

Original Category OBC Category for Admission OBC

Original Other Category --

Other Category for Admission --

Admission under Technical Reservation (25% for HSVC & Bifocal Courses)

Have you opted any of the Pre-Vocational Courses or Subjects offered under NSQF at 10th Examination ? No

Admission for Inhouse Quota

Do you want to take admission through Inhouse Quota ? No

10th Standard Examination Details

Passing Status Pass Passed in Science Subject Yes

English Marks 71 / 100 English Percentage 71.00%

Total Marks 382 / 500 Total Percentage 76.40%

Documents Verification Details

Documents Verification Type Online

1617126 - BHAURAO POTE VIDYALAYA, KALYAN (W), THANE

Documents Verification At
(Contact Person : , Contact No. : 8080802226, Contact Timing : 11:00 AM to 05:00 PM)

Required Documents List

Sr. No. Document Name Original Category Verified Category Verification Status Verification Date

1. 10th Standard Marksheet. -- -- Pending --

2. School Leaving Certificate. -- -- Pending --

3. Caste Certificate. OBC -- Pending --

4. Non-Creamy Layer Certificate. -- -- Pending --

5. Self Declaration / Undertaking of Student. -- -- Pending --

Note :
1. You need to get your form verified from your secondary school / selected guidance centre. For this purpose, you can contact to the school / guidance centre over phone
which is mantioned in your print out. It is not required to visit the school / guidance centre personally.

2. Unless and until the application form is verified by respective school / guidance centre, you can not proceed to fill the option form.

Declaration

I hereby declare & understand that,

1. All the information furnished by me in this online application form is true, complete and correct to the best of my knowledge and belief.
2. Entire information furnished by me in this application is final and binding to me.
3. If any information furnished by me here, is found to be false or incorrect, i shall be liable for appropriate legal action and my admission will be cancelled as per rules.
*Note : I will submit all the original documents required for admision (uploaded and not uploaded) while taking admission.

Place :                                                                        Date : 14/08/2021

Printed On : 14/08/2021 8:11:26 PM

Last Modified On : 14/08/2021 8:00:31 PM

Applicant Signature

Last Modified By : MU1130136, 103.127.20.110:2339/Chrome/Windows 10/N (PATIL VAIBHAV ANANTA)

Current Status : Locked | Not Verified by Secondary School / Guidance Centre

https://mumbai.11thadmission.org.in/Candidate/PrintApplicationForm.aspx?P1=130136&P2=672401938 1/1