Session 2021-2022

RISHI DAYARAM AND SETH Application for

HASSARAM NATIONAL COLLEGE Admission to TYBMS
AND SETH WASSIAMULL SEM 5
ASSOMULL SCIENCE COLLEGE Session 2021-2022
SMT. JOTU KUNDNANI CHOWK, OFF Application No. :10
LINKING ROAD, BANDRA - WEST,
MUMBAI, MAHARASHTRA, INDIA
POSTAL CODE 400 050 TEL. NOS. (91 -
22) 2648 3544 / 2604 1777 FAX NO.
Applicant's Personal Details

Name of the Student Surname First name Father's name

KOGTA SHUBHAM RAJKUMAR

Mother's Name SARIKA KOGTA

Student Name(MARATHI) शशभम

Date of Birth 15/12/2001 Place Of Birth JALGAON

Birth State Blood Group O+

Birth Tehsil Gender MALE

Marital Status UNMARRIED Aadhaar card Number 944172016965

Religion HINDU PRN Number 2019016401888064

Nationality INDIAN Enrollment Number

Mother Tongue HINDI Employment Status Unemployed

NCC/NSS NO Caste Category OPEN

Handicap NA

Student has a Desktop/ YES Student has internet YES

Laptop/ Smart phone connectivity

Municipal Ward

Father's/Husband's Name RAJKUMAR KOGTA

Occupation Gross Annual Income 200,000

Mobile 9422296810

Address of Correspondence

Address 17/301 manas aastha heights mayadevi nagar near rotary club , jalgaon

State Maharashtra District Jalgaon

Pincode 425001 City/Town/Village JALGAON

Permanent/Native Address

Address 17/301 manas aastha heights mayadevi nagar near rotary club , jalgaon

State Maharashtra District Jalgaon

Pincode 425001 City/Town/Village JALGAON

Contact Details

Student Phone 9511765153 Parent's Phone

Mobile 9511765153

Email Id shubham.r.kogta@gmail.com

Payment mode Offline

Last Exam Details

Exam Name

Name of Board/
University

Month Year

Roll Number Division

Marks Obtained Maximum Marks

Percentage Result

Exam Details

Sr.No. Course Name SGPA CGPA

1 FYBMS SEM 1 8.15 8.15
2 FYBMS SEM 2 8.15 7.48
3 SYBMS SEM 3 9.85 9.85
4 SYBMS SEM 4 9.70 8.72

Sr.No. Subject Name Subject Type

Group Name : GROUP B - MARKETING ELECTIVES

1 CORE COURSE - LOGISTICS & SUPPLY CHAIN MANAGEMENT COMPULSORY

2 ABILITY ENHANCEMENT COURSE - CORPORATE COMMUNICATION & PUBLIC COMPULSORY

RELATIONS

3 SERVICES MARKETING OPTIONAL

4 E-COMMERCE & DIGITAL MARKETING OPTIONAL

5 SALES & DISTRIBUTION MANAGEMENT OPTIONAL

6 STRATEGIC MARKETING MANAGEMENT OPTIONAL

Declaration by Student

I hereby declare that, I have read the rules related to admission and the information filled in by me in this form is accurate
and true to the best of my knowledge. I will be responsible for any discrepancy, arising out of the form signed by me and I undertake
that, in absence of any document the final admission will not be granted and / or admission will stand cancel.

Date : 05/06/2021 Signature of the Student

Declaration by Guardian / Parent

I have permitted my son / daughter / ward to join your college.The information supplied by him / her is correct to the best of
my knowledge. I have acquainted myself with the rules and fees, dues to my son / daughter / ward and see that he / she observes.

Date : 05/06/2021 Signature of the Guardian/Parent

 For College / Institute Use Only

Designation Remarks / Particulars /Recommendations Signature and Date

Admission Clerk

Admission Committee

Accountant / cashier

Registrar/Office
superintendent

REMARK OF THE ADMISSION COMMITTEE

May be admitted to Class ____________________________________________________ Section ________________

May be Rejected __________________________________________________________________________________
Last date of payment of fees _________________________________________________________________________
Admission may be cancelled if the fees are not paid by this date.

Principal Signature of Admission Committee

Other Details