Dr. D. Y. Patil Vidya Pratishthan Society's Form No.

Dr. D. Y. PATIL ARTS, COMMERCE & SCIENCE COLLEGE

Pimpri. Pune - 411018
(Affiliated to Savitribai Phule Pune University ID. No. PU/PN/ACS/111/1995)
Phone : 020-27424194, 27423593, FAX : (020) 27420711, Email : info.acs@dypvp.edu.in
Re-accredited by 'NAAC' with 'A' Grade (CGPA - 3.28 out of 4)
Roll No.
APPLICATION FORM FOR ADMISSION

Admission for the Course F.Y.B.A. Year 2016-2017

Application No. : 1408 Eligibility No. :

Candidate's Name : Ananya Mother's Name : Akshara Gupta

Place of Birth : Puducherry Date of Birth : 01/08/1996

Blood Group : B+ Organ Donation : Yes

Gender : Female Cell No. : 9669190002

Permanent Address : Gwalior Polyclinic Opp. Madhav Dispensary Hospital Road Lashkar Gwalior M.P.

Email ID : achal23@gmail.com Aadhar Card No. :

Local Address : Gwalior Polyclinic Opp. Madhav Dispensary Hospital Road Lashkar Gwalior M.P.

Rural / Urban : Urban Marital Status : Unmarried Mother Tongue : Hindi

Nationality : Indian State of Domicile : Madhya Pradesh Religion : Hindu

Caste : Vaishya Category : Open Minority : -

Fee Category : PAYING Ex.ServiceMen : No Phy.Handicaped : No

INFORMATION OF THE PARENT'S / GUARDIAN

Parent's Name : Achal Gupta

Address : Gwalior Polyclinic Opp. Madhav Dispensary Hospital Road Lashkar Gwalior M.P.

Cell No. : 9329790002 Email ID : achal23@gmail.com

Occupation : Doctor Central Govt. Employee : Gr Medical College Gwalior M.P.

Relation : Father Annual Income : 24000000

ACADEMIC INFORMATION (PREVIOUS EXAMINATION PASSED)

Exam H.S.C Board/ Year of Center & Obtained/ Percentage School/College from which
University Passing Seat No. Total Marks passed

12Th Central Board Of May 2015 KV NO. 3 372/500 74.40% Silver Bells School Madhya Pradesh
Secondary ROLL NO.
Education 1686726

SUBJECTS OF CHOICE
1. Compulsory English 2. Physical Education 3. Geography General 4. Psychology General 5. Optional English 6.
Economics 7. Introduction to Sociology

Your's obediently

Place :

Date :
Signature of Student