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Birla College of Arts, Science and Commerce (23)

Birla College Road.

Kalyan

Application No :

University of Mumbai 2418983

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

Academic Year: 2022-2023

Regular
APPLICATION FORM

Course Applied for : M.Sc (Autonomous)(with Credits) - Regular - CBCS - M.Sc. Part I Sem I 
(-) PRN:2017016400079127

Application Date : 18/08/2022 Payment Category :

1.Personal Information

Candidate's Name(Regional) :
Candidate's Name as printed on Mark GUPTA SATYAM MUKUNDRILAL
sheet : [*This name will appear on all University records/documents]

Father's/Husband's Name : MUKUNDRILAL Mother's Name : PARMESHWARI

Marital Status : UnMarried Mother Tongue :

Place Of Birth : ULHASNAGAR Gender : Male Date of Birth (DD/MM/YYYY) : 13/03/1999
Blood Group : Religion : Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Thane Tehsil : Kalyan City/Town/Village :
Available
Address (House
SHAHAD FATAK MURBAD ROAD JOYA APARTMENT Pin Code : 421001
no,street/area/suburb etc.) :
Contact details
Mobile Number 8177860365 Email ID: gsat81770@gmail.com
2.Legal Reservation Information
Category Type : Open Category : GEN
Is Guardian from EBC (Economic Backward
Is Specially Abled? No
Class)?  No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem I
AIMSCSI.101 - Paper 1 AIMSCSI.102 - Paper 2
AIMSCSI.103 - Paper 3 AIMSCSI.104 - Paper 4
Sem II

AIMSCSI.201 - Paper 1 AIMSCSI.202 - Paper 2

AIMSCSI.203 - Paper 3 AIMSCSI.204 - Paper 4

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Laborer Annual Income of Guardian : 48000
5.Educational Details
Month and Exam
Name of Name of Board/University and State of Name of Certificate Mark
Year of Seat Out of CGPA %
Examination University School/College No. Obtained
Passing No.
 Month and Exam
Name of Name of Board/University and State of Name of Certificate Mark
Year of Seat Out of CGPA %
Examination University School/College No. Obtained
Passing No.
MAHARASHTRA STATE BOARD OF
Std 10th SECONDARY AND HIGHER March 2014 -- -- 392.00 500.00 --
-
-- 78.40
SECONDARY EDUCATION,
MAHARASHTRA STATE BOARD OF
Std 12th 12Th
SECONDARY AND HIGHER July 2016 -- -- 228.00 650.00 --
-
-- 35.08
(Science)
SECONDARY EDUCATION,
Degree : B.Sc.(With
Credits)-Regular- Passed -- -- - - --
-
-- -
Rev16
Your Last Qualifying Exam: B.Sc.(With Credits)-Regular-Rev16
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.

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 :2418983 (GUPTA SATYAM MUKUNDRILAL)
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 Remarks / Particulars / Recommendations Signature and Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: INR Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Thu Aug 18 2022 15:23:35 GMT+0530 (India Standard Time)