Personal Details

Application Sequence No Candidate's First Name

TMH006060 PALLAVI
Candidate's Middle Name Candidate's Last Name
Ambarsing Pawar
Father's Name Mother's Name

Ambarsing MANGLA
Date of Birth (DD-MM-YYYY) same as Matriculation/ Secondary Certificate Age as on 02.08.2021
09/03/2001 20 Years 4 Months 24 Days

Gender Category
Female General (UR)

Are you PWD? Marital Status

No Single
Nationality
Indian

Contact Details

Mobile Number
9881045896
Email ID

pawaramber16@gmail.com

Present Address

Address Line 1
Pimpaldar Satana

Address Line 2

Khamtane

Address Line 3

Baglan

Country

India

State Town/City

Maharashtra Nashik

Pin Code Is Permanent Address same as Correspondence address?

423301 Yes

Permanent Address

Address Line 1
Pimpaldar Satana

Address Line 2

Khamtane

Address Line 3
Baglan
 Country

India

State Town/City

Maharashtra Nashik

Pin Code

423301

Work Details

Are you currently working in Tata Memorial Center?

No

Course Selection

Subject

Advance Diploma in Medical Imaging Technology (ADMIT)

Graduation Subject For B.Sc./Other Graduates – Degree Status

B.Sc Appearing

Graduation Percentage

Sr.No Degree Institution/College University Name Month & Year of passing Subject

1 B.Sc 1st Year K.A.A.N.M. Sonawane arts , Commerce and Savtirbai Phule Pune University 12/2019 M Z B C Microbiology , Zoology, Botany,
Science College, Satana Chemistry

2 B.Sc 2nd Year K.A. A. N. M. Sonawane Arts, Commerce and Savitribai Phule Pune University 07/2020 M Z B Microbiology ,Zoology , Botany
Science College, Satana

3 B.Sc 3rd Year K.A.A. N. M. Sonawane Arts, Commerce and Savitribai Phule Pune University 05/2021 Zoology
Science College, Satana

4 B.Sc 4th Year

Attached Documents

Document/Certificate Attached Self Attested

Educational Qualification
Yes No

Note: "ALL SEMESTER MARKSHEETS OF B.Sc/B.Pharm / BOTh or Equivalent TO BE UPLOADED."

Caste Certificate Yes No

Non-Creamy Layer Certificates for reserved category Yes No

Marriage Registration in case of married female application Yes No

High School Certificate or Equivalent showing date of birth Yes No

Payment Details

Amount to be Paid Payment Mode

1000 online

Payment Status Payment Transaction No.

S 71758135311

Candidate Documents/Images Upload Details

Photo

Signature

Declaration
I have read the information provided. I declare that all information furnished above by me is correct and true. I have attached attested / certified copies of all certificates / marks sheets. In case any information furnished by me is found wrong at any time, my candidature for the
examination / selection to the course may be cancelled outright and I will be debarred permanently from this test. I declare that I am Indian National. There are no disciplinary actions or criminal cases against me and I have not been debarred by any University or Bodies for appearing in
an examnination or seeking admission to higher studies.