Indian Institute of Technology, Bombay

Powai, Mumbai - 400 076

M.Tech Admission 2022 - 2023

Form ID : B219370244

Payment Details
Transaction Ref. No. 1942286104933 Transaction Date 2022-03-31
Amount 300.00 Banker's Name SBI Internet Banking
1. Name: SACHIN YADORAO BISEN
2. (a) GATE records
Reg. No. 22S72059009 (ME) Year 2022
Score 546.00 All India Rank (AIR) 3951
2. (b) Other Competitive (All India) Exam Score, if any
(Like AIIMS/MCI/JIPMER/PGI-Chandigarh/AFMC-Pune/DNB-part-I)
Exam Name
Year Score

Applicant Personal Details

3. (a) Address of the candidate (for postal (b) Name & Address of Parent/Guardian (i.e. Permanent
communication) Address)
Sane Guruji Nagar Manekasa Poketola
Kamtha Road Bangaon Amgaon Amgaon
City Amgaon City Amgaon
State Maharashtra State Maharashtra
Pin 441902 Pin 441902
4. Telephone (with STD code) : Mobile: 7057718818
Email: bisensachin25@gmail.com
5. Date of Birth: 1999-06-16 6. Gender: Male
7a. Birth Category: OBC-NC 7b. Physically Challenged(Y/N): N
8. Nationality: I
Qualifying Degree Details
9. Qualifying Degree: B.Tech.
9a. Mode of Programme (Regular or Correspondence): Regular (Full time) 9b. Duration of programme : 4 yrs.
10. Qualifying Discipline: ME 11. Status of Examination: Results Declared

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12. Details of Academic record (Secondary onwards)
Specialization Year of Avg %age of
Examination Passed Institute/University Class/Division
/Discipline Passing Marks/Grade
Mechanical Government College of
B.Tech. 2021 8.26/10 First Class
Engineering Engineering Jalgaon
10th Board Science Adarsh Vidyalaya Amgaon 2015 80.80/100 First Class
12th Board Science Adarsh Jr College Amgaon 2017 76/100 First Class
13. Specializations applied for (in order of preference)
Preference order 1 2 3 4 5 6 7 8 9 10

Specializations ME2 ME1 ME3 IO AE1 CE5 AE4 AE3 AE2 MM4
14. Categories under which you want to apply
1. TA/TAP 2. RA/PA
14a. M.Tech + Ph.D. (Dual Degree) [Only for Electrical Engineering]
Are you interested to be considered for admissions to M.Tech. + Ph.D. (Dual Degree) Programme under TA category?
No
14b. M.S By Research [Only for Computer Science Engineering]
Are you interested to be considered for admissions to M.S By Research Programme under TA/RA category. No
14c. M.S. by Research in Data Science and Artifiicial Intelligence in CMinds.
Are you interested to be considered for admissions to M.S. by Research in Data Science and Artifiicial Intelligence in
CMinds under TA/RA category. No
14d. If applying to Environmental Science & Engineering (EV)/Geoinformatics & Natural Resources Engineering
(GNR),For applicants with M.Sc. as qualifying degree, Mathematics is essential at Higher Secondary/ Intermediate
(10+2) level
If your qualifying degree is M.Sc., have you done Mathematics is at Higher Secondary/ Intermediate (10+2) level?
Not Applicable
14e. If applying to Metallurgical Engineering and Materials Science, For applicants with M.Sc. as qualifying degree,
Mathematics is essential at B.Sc. degree level.
If your qualifying degree is M.Sc., have you done Mathematics is at B.Sc. degree level?
Not Applicable
COAP Registration Number : COAP22003231
15. Publications, if any: No. of Papers published 0
16. Employment Details (after acquiring qualifying degree) Total Duration (in months):0
Date
Name of the Organisation Designation
From To
17. Present Employment status: (Employed/Not Employed) Not Employed
18. Declaration: I certify that the information given above is correct. I am fully aware that I must submit attested
copies of my qualifying degree certificate / final transcripts on or before July 31st, 2022, failing which, my admission
will stand cancelled. I am also aware that providing incorrect information in the application form can result in the
cancellation of my admission at any stage.

PlaceAmgaon Date31-3-2022 Signature of the Applicant

Attached Documents :
1 Qualifying Degree :
2 Caste Certificate

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Page 3 of 6
 ORIGINAL

1 2 85 2 20128 4003137421

FORM -9
Rule No. 5 (6)]
to post under
Classes person applying for Appointment
Form of Caste Certificate for Other Backward Government of India.
of education under the
purpose
the Government of India or for the

Documents Verified

arj Tahsildar
2.. Income Certiflcate for the last 3 years
issued by the
3. Rahiwasi
Of Father
4. Copy of School Leaving Certificate
Certificate Of Beneficiary
5. Copy of School Leaving

CASTE CERTIFICATE

Application Date 28/01/2022

Outward No 40514250740
40514250740
MRC
Rev Case No

Isheshwar Bisen of
Sachin Yadorao Bisen Son
of Shri Yadorao
that Kumar to the Powar
This is to certify in the State of Maharashtra belongs
Manekasa, Tehsil Amgaon, in District Gondiya under the
Village 216 which is recognized
as a backward class
Caste/Community at Sr No. 10th September 1993 published
No.12011/68/93-BCC (C), dated the
Government of India Resolution dated the 13th September
1993.
i) Part-, Section-l, No.186,
in the Gazette of India, Extraordinary, dated 19th October 1994
Resolution No.12011/9/94-BCC,
Government of India, Ministry of Welfare, dated 20th October 1994.
ii) Part-, Section-l, No.163
published of India, Extraordinary,
in Gazette Gazette of India, Extraordinary,
the 24 th May 1995 in the
Resolution No.12011/7/95-BCC, dated
iil)
No.88, dated 25 th May 1995.
Part-l, Section-1, dated 9th March,1996
Welfare No. 12011/96/94-BCC
Resolution
Government of India, Ministry of No.60 dated 11th March,1996
iv) Gazette of India Extraordinary
Part-1, Section-1,
published in the N o . 1 2 0 1 1 / 4 4 / 9 6 - B C C dated 6th December,
1996
Welfare Resolution
VvGovernment of India, Ministry of
No.210 dated 11th December, 1996
Part-1, Section-1,
Gazette of lndia Extraordinary N o . 1 2 0 1 1 / 9 9 / 9 4 - B C C dated
11th
published in the Resolution
G o v e r n m e n t of India,
Ministry of V lfare Section-1, No.236 dated 12th
vi) Extraordinary Part-1,
in the Gazette of India
December, 1997 published
December, 1997 No.12011/13/97-BCC dated 3rd December,1997
Resolution
Government of India, Ministry
of Welfare
Section-1, No.239
dated 17th December, 1997
vil) Gazette of India Extraordinary
Part-1,
published in the Resolution No.12011/68/98-BcC
Justice and Empowerment
Government of India, Ministry of Social Gazette of India Extraordinary
Part-1, Section-1,
vii) 27th October, 1999 published in the
dated the
No.241 dated the 27th
October, 1999. No.12011/88/98-BCC
Empowerment Resolution
India, Ministry of Social Justice and Part-1, Section-1, No.270
of Extraordinary
ix) Government
published in the Gazette of India
1999
dated 6th December,
1999.
dated the 6th December,

Page 4 of 6
 Government ofIndia, Ministry of Social Justice and Empowerment Resolution No.12011/36/99-BCC dated 4th
April, 2000 published in the Gazette of India Extraordinary Part-1, Section-1, No.71 dated 4th April, 2000
x) Government of India, Ministry of SoclalJustice and Empowerment Resolution No.12011/44/99-BCC dated
21th September, 2000 publishedin the Gazette of India Extraordinary Part-1, Setion-1, No.210 dated 21th
September, 2000.
xi) Government of India, Ministry of Social Justice and Empowerment Resolution No.12015/9/2000-BCC dated
6th September, 2000 published in the Gazete of India Extraordinary Part-1, Section-1, No.246 dated 6th
September 2000.
xii) Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/1/2001-BCC dated
19th June, 2003 published in the Gazette of India Extraordinary Part-1, Section-1, No.151 dated 20th
June,2003.
xv) Government of Ihdia, Ministry of Social Justice and Empowerment Resolution No.12011/4/2002-BCC dated
13th January, 2004 published in the Gazette of India Extraordinary Part-1, Section-1, No.9 dated 13th
January, 2004.
xw) Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/14/2004-BCC dated
12thMarch, 2007 published in the Gazette of India Extraordinary Part-1, Section-1, No.67 dated 12th
March,2007
i)Government of lIndia, Ministry of Social Justice and Empowerment Resolution No.12015/2/2007-BCC dateq
18th August, 2010 published in the Gazette of India Extraordinary Part-1, Section-1, No.67 dated 18th
August, 2010.
xvii) Government of India, Ministry of Social Justice and Empowerment Resolution No.12015/2/2007-BCC dated
11th October, 2010 published in the Gazette of India Extraordinary Part-1, Section-1, No.274 dated 12th
October, 2010
xvii) Government of India, Ministry of Social Justice and Empowerment Resolution No.12015/15/2008-BCC dated
16th June,2011 published in the Gazette of India Extraordinary Part-1, Section-1, No.123 dated 16th June
2011.
xix) Government of India, Ministry of Social Justice and Empowerment Resolution No.12015/13/2010-BC-II dated
8th December, 2011 published in the Gazette of India Extraordinary Part-1, Section-1, No.257 dated 8th
December, 2011
o) Government of India, Ministry of Social Justice and Empowerment Resolution No.12015/05/2010-BC-lI dated
17th February, 2014 published in the Gazette of lndia Extraordinary Part-1, Section-1, No.41 dated 17th
February.2014
oxi) Government of India, Ministry of Social Justice and Empowerment Resolution No.20012/129/2009-BC-
dated 4th March, 2014 published in the Gazette of India Extraordinary Part-1, Section-1, No.63 dated 4th
March,2014.
xi) Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/04/2014-BC-l dated
the 14thJanuary, 2015 published in the Gazette of India Extraordinary Part-1, Section-1, No.16 datedthe 14th
January, 2015.
xoxii) Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/07/2014-BC-ll dated
the 23rdJanuary, 2015 published in the Gazette of India Extraordinary Part-l, Section-1, No.26 dated the
23rd January, 2015.
oiv) Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/01/2015-BC-Il dated
the 27th May, 2015 published in the Gazette of India Extraordinary Part-l, Section-1, No.144 dated the 27th
May, 2015.
ov) Government of India, Ministry of Social Justice and Empowerment Resolution No.12015/05/2011-BC-Il dateq
the14thJuly, 2015 published in the Gazette of India Extraordinary Part-l, Section-1, No.191 dated the 15th
July, 2015.
om) Governmentof India, Ministry of Social Justice and Empowerment Resolution No.12011/06/2014-BC-Il dated
the09thSeptember, 2015 published in the Gazette of India Extraordinary Part, Section-1, No.234 dated the
09th September, 2015,
xxvi) Govenment ofIndia, Ministry of Social Justice and Empowerment Resolution No.12011/13/2016-BC-II dated
the 26th May,2016 published in the Gazette of lndia Extraordinary Part-l, Section-1, No.160 dated the 26th
May, 2016.

Page 5 of 6
 No.12011/14/2016-BC-II
XXvili) Government of India, Ministry of Social Justice and Empowerment Resolution
dated the 13thJune, 2016 published in the Gazette of India Extraordinary Part-l, Section-1, No.188 dated

the 15th June, 2016.

xXIX) Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/15/2016-BC-I
dated the 30thJune, 2016 published in the Gazette of India Extraordinary Part-, Section-1, No.206 dated

the 30th June, 2016.

Resolution No. 12011/04/2014-BC-II
Xox) Government of India, Ministry of Social Justice and Empowerment
dated the 11thAugust, 2016 published in the Gazette of India Extraordinary Part-I, Section-1, No.266
dated the 11th August, 2016.
Resolution No.12011/06/2014-BC-II
XXox) Government of India, Ministry of Social Justice and Empowerment
dated the 06thDecember, 2016 published in the Gazette of India Extraordinary Part-l, Section-1, No.363
dated the 07th December, 2016.
Resolution No.12011/13/2016-BC-II
Xxii) Government of India, Ministry of Social Justice and Empowerment
dated the 22nd December, 2016 published in the Gazette of India Extraordinary Part-l, Section-1, No.374
dated the 22nd December, 2016.
No.20012/01/2017-BC-Il
oxii) Government of India, Ministry of Social Justice and Empowerment Resolution
2017 published in the Gazette of India Extraordinary Part-I, Section-1, No.18
dated the 18thJanuary,
dated the 19th January, 2017.
Kumar Sachin Yadorao Bisen and/ or his family ordinarily reside(s) in Village Manekasa, Tehsil

Amgaon, in District Gondiya of the Maharashtra State.

This is also to certify that he does not belong to the persons/sections (Creamy Layer) mentioned in
Training Personnel & O.M. No.
column 3 of the Schedule to the Government of India, Department of
36012/22/93-Estt (SCT) dated 8-9-1993 O.M. 36033/3/2004-Estt.(Res.) dated 9th March, 2004 and
dated 27th
O.M.No.36033/3/2004-Estt. (Res.) dated 14th October, 2008 and O.M. No. 36033/1/2013-Estt.(Res.)
May, 2013.

Signature valid
Digitally Sigged by
AnmoksACAr
Date:202-02-4P 6tie36 PM
Place Deori
15/02/2022 (With the seal of Office) Deori
Date
Printed By-OMTID MHO97501805 VLE Name Tahsildar Amgaon, Date:15/02/2022 6:14PM
This is a digitally signed document, hence is legally valid as per the Information Technology (IT) Act, 2000.
To verify visit https://www.mahaonline.gov.in/Verify OR SMS "MH<space>cSC<space>VRFY<20 digit Barcode number>" to 166 from a BSNL, MTNL, Tata Mobile and

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