Pune Vidyarthi Griha's

COLLEGE OF ENGINEERING AND TECHNOLOGY AND G. K. PATE (WANI)

INSTITUTE OF MANAGEMENT, PUNE
'VIDYANAGARI' S.NO.44, PARVATI, PUNE 411 009 411030 02024228258 02024226858

Affiliated to the Savitribai Phule Pune University P/PN/066/Engg/1985

APPLICATION FORM FOR CONTINUING IN THE COLLEGE BY ADMISSION TO SE / TE / BE / ME COURSE IN

ENGINEERING DURING YEAR 2022-23
College PRN No. 21114025 Roll No. 1025 Year of Admission in COET(FE / Direct SE) 2021-22
Fees Paid Rs. 104500 Demand Draft/Check No. DD/Check No.
Date
Drawn On Receipt No. Student's A/c No. 60339070646
Class of SE Gender Male Hostel No Freeship No
Admission
Branch Mechanical Adm. Category CAP Fee Category Open Scholarship No

Religion Hindu Caste Bramhin Sub Caste BRAHMIN Caste Category Open
State MS OM State Email Id shubhan.s.thakar@gmail.com
Date of Birth 27-Nov-2003 Place of Birth TOKYO JAPAN Birth District TOKYO Nationality INDIAN
Blood Group A+ Physically Handicap NA Permanent Residence in Urban
Name of the Candidate in full as expected on University Certificate/Marklist in Capital letters
Surname First Name Father's Name Mother's Name
THAKAR SHUBHAN SHACHINDRA UJJWALA
Mobile and Residential No. 7499392546 9588607557 9325309916
Parent's Name and Address Student's Local Address Local guardian's Name and Local Guardian's Mobile and
Address Phone No.
SHACHINDRA NISHIKANT G-3,GANESH,VIBHAV
THAKAR APTS.,NEAR MAHATMA
G-3,GANESH,VIBHAV SOCIETY,KOTHRUD,PUNE-38
APTS.,NEAR MAHATMA India,Maharashtra,Pune,HAVELI,P
SOCIETY,KOTHRUD,PUNE-38 UNE,411038
India,Maharashtra,Pune,HAVELI,
PUNE,411038
Family Annual Income (Rs) 1000000/-
Details of previous Examination passed :

Course Name of Exam Passed Exam Seat Month Marks Result( Percentage Class/SGPA If YD in TE and
Year No. and year Obtained / Pass/ATKT/F % BE ,give reason
of Out of ail) /Earned for YD year
Passing Credit
2022 FE 1st Semester F190070494 april 2022 558 / 650 22 85.84 9.36 NA
2022 FE 2nd Semester F190070494 SEPTEM 384 / 650 22 59.07 8.05 NA
BER 2022
SE 1st Semester /
SE 2nd Semester /
TE 1st Semester /
TE 2nd Semester /
BE 1st Semester /
BE 2nd Semester /

Document List:

Sr.No. Document Name Submit

1 Seat Acceptance Letter given by DTE/CET Cell(Allotment Letter)
2 Nationality Certificate
3 Leaving /Transfer Certificate (For last Attended Institute)
4 CET Score Card
5 H.S.C./12th Marks Sheet
6 S.S.C./10th Marks Sheet
7 Domicile Certificate
8 Aadhar Card
9 JEE Mains Score Card
10 Provisional Certificate

According to the result of FE in Mechanical branch. I request you to admit me to SE in Mechanical branch for the academic year 2022-23
(Attach photo-copy of the statement of marks of previous examination.)

Signature of the Parent / Local Guardian Signature of the Candidate

Date : Principal

Place : P.V.G.'s C.O.E.T. Pune