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Birla College of Arts, Science and Commerce (23)

Birla College Road.

Kalyan
Application No :

University of Mumbai
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)

123333

Academic Year: 2022-2023 Regular

APPLICATION FORM

Course Applied for : B.Sc. (Autonomous)(with Credits) - Regular - CBCS - F.Y.B.Sc. (Autonomous) Sem I  PRN:
(-)

Application Date : 12/06/2022 Payment Category :

1.Personal Information
Candidate's Name(Regional) : नाचणं टान्झा नदीम
NACHAN TANAZA NADEEM
Candidate's Name as printed on
[*This name will appear on all University

Mark sheet :
records/documents]

Father's/Husband's Name : NADEEM Mother's Name : AALIYA

Marital Status : UnMarried Mother Tongue : Hindi
Place Of Birth : KALYAN Gender : Female Date of Birth (DD/MM/YYYY) : 25/05/2005
Blood Group : Religion : Muslim Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
City/Town/Village :
State : Maharashtra District : Thane Tehsil : Kalyan Location Area : Urban
KALYAN
Address (House
NACHAN HOUSE DHUDHNAKA CHAUDHARI MOHALA BUNDER ROAD
no,street/area/suburb Pin Code : 421301
KALYAN
etc.) :
Permanent Address :
City/Town/Village :
State : Maharashtra District : Thane Tehsil : Kalyan Location Area : Urban
KALYAN
NACHAN HOUSE DHUDHNAKA CHAUDHARI MOHALA BUNDER ROAD
Address : Pin Code : 421301
KALYAN
Contact details
Mobile
8433789315 Email ID: nachanahmed22@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : GEN
Open
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)?  No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem I
BSC 1.1 - Paper 1 BSC 1.2 - Paper 2
BSC 1.3 - Paper 3 BSC 1.4 - Paper 4
Sem II

BSC 2.1 - Paper 5 BSC 2.2 - Paper 6

BSC 2.3 - Paper 7 BSC 2.4 - Paper 8
Medium of Instruction : English
4.Guardian Information
Occupation of Guardian : Business Annual Income of Guardian : 150000
5.Educational Details
Month
Name of Name of Board/University Name of and Exam Certificate Mark Out
CGPA %
Examination and State of University School/College Year of Seat No. No. Obtained of
Passing
MAHARASHTRA STATE BOARD
OF SECONDARY AND HIGHER ALFA ENGLISH March
Std 10th A061715 -- 356.00 500.00 --
-
-- 71.20
SECONDARY HIGHSCHOOL 2020
EDUCATION,Maharashtra
MAHARASHTRA STATE BOARD
M K MAHENDRA
Std 12th OF SECONDARY AND HIGHER June
SINGH KABUL M017885 -- 339.00 600.00 --
-
-- 56.50
Science SECONDARY 2022
SINGH GANDHI
EDUCATION,Maharashtra
Your Last Qualifying Exam: HSC/Std 12th [Science]
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Passing Certificate of Std 12th / Statement of Marks of Std 12th OR Original Passing Certificate /Statement of Marks of Last
Qualifying Exam like degree,diploma,etc.

Passing Certificate of Std 10th.

Leaving Certificate.

DECLARATION
I hereby declare that all the information furnished by me in this application form
is true, complete and correct to the best of my
knowledge and belief. I do understand
that I need to obtain and produce all the required documents.
I
Application No :123333
(NACHAN TANAZA NADEEM)
admit to having understood what constitutes ragging and sexual harassment. I have
read the
guidelines related to the same. I hereby affirm that if found guilty of
ragging or sexual harassment I am liable for punishment
according to the university
regulations.

Place : Date  :
( Signature of the Candidate )
For College/Institute/Study Center Use Only
Designation Signature and
Remarks / Particulars / Recommendations
Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: INR Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Sun Jun 12 2022 11:45:17 GMT+0530 (India Standard Time)