Fees Receipt No. __________ Dt. _______________ Amt _______________ Form No. 22104

B. K. BIRLA COLLEGE
OF ARTS, SCIENCE AND COMMERCE (Autonomous),
KALYAN
Affiliated to University of Mumbai
ADMISSION FORM

T.Y.B.COM. (2019-2020) Division: _______

Roll No: ________

The Principal,
B. K. BIRLA COLLEGE OF ARTS, SCIENCE AND COMMERCE (Autonomous), KALYAN
Kalyan

I wish to apply for admission to the T.Y.B.Com.  Class. I give below the necessary particulars.

Student Name BHARAMBE HARSHAL CHUDAMAN

Mother's Name ARCHANA

Sex Male Aadhar Card No. 849727469920

Marital Status Unmarried Blood Group O+

Date of Birth 04-Oct-1999 Place of Birth UMBERKHEDE

Nationality Indian Mother Tongue Marathi

Religion Hindu Category OBC

Caste : LEVA PATIL SubCaste

Correspondence Address 901,A1,IRIS YOGIDHAM COMOLEX, YOGIDHAM, GAURIPADA,KALYAN (W) - 421301 - 421301

Native Place Address 901,A1,IRIS YOGIDHAM COMOLEX, YOGIDHAM, GAURIPADA,KALYAN (W)

Native District THANE Native State Maharashtra

Telephone No. (Resi)

Student Mobile No. 8976187967 Guardian Mobile No. 9892699122

Email ID harshalbharambe.7@gmail.com Guardian Email ID chudamanbharambe.7@gmail.com

Physically Challenged N/A

Have you Enrolled for Voter's List? Yes

Subjects Offered Commerce Paper III (MHRM)

Business Economics III

Financial Accounting

Financial Accounting - Auditing

Financial Accounting - Costing

Direct & Indirect Taxes

Purchase and Store Keeping

P.T.O.
 Form No. 22104

Mon. & Year of Total Out of / Attempt /

Examination Name of the Board / University Name of the College Seat No
Passing Marks Grade SGPA

B.K. BIRLA COLLEGE (FORMERLY BIRLA

Sem 1 UNIVERSITY OF MUMBAI NOV 2017 15041 20.00 A+ 9.45
COLLEGE)

B.K. BIRLA COLLEGE (FORMERLY BIRLA

Sem 2 UNIVERSITY OF MUMBAI APR 2018 25042 20.00 A 8.25
COLLEGE)

B.K. BIRLA COLLEGE (FORMERLY BIRLA

Sem 3 UNIVERSITY OF MUMBAI NOV 2018 35160 20.00 A 8.6
COLLEGE)

B.K. BIRLA COLLEGE (FORMERLY BIRLA

Sem 4 UNIVERSITY OF MUMBAI APR 2019 45162 20.00 A 8.6
COLLEGE)

Parents / Guardian Details

Name CHUDAMAN BHARAMBE Relationship FATHER
Office Address FA & CAO (T`S) ACCOUNTS BUILDING, ABOVE PLATFORM NO. 7, CSMT
Occupation SERVICE
Annual Income (Rs.) 850000

DECLARATION BY STUDENT
1. I hereby declare that I have read all the rules and regulations framed by the college authorities as given in the college prospectus, which are presently
in force.
2. I hereby declare and undertake to abide by all the mentioned rules and regulations and hereby agree, if admitted, to confirm to them and to such other
rules as may hereafter be made for the smooth functioning of the college.
3. I may not be granted terms or allowed to appear for the College / University Examination if my attendance in lectures and tutorials / practicals falls
short of 75%.
4. I may not be granted any concession in any matter, if I take up any employment during the course of my studies.
5. I hereby declare that I shall show satisfactory progress and maintain good conduct.
6. I hereby declare that I have not registered my name at any other institution for any other full time course.
7. I hereby declare that the information filled in by me in this form is accurate and true to the best of my knowledge I will be responsible for any
discrepancy, arising out of the form signed by me and I undertake that, in absence of any document the final admission will not be granted and / or
admission will stand cancelled.
8. I WILL DISPLAY MY IDENTITY CARD PROMINENTLY IN THE COLLEGE PREMISES.
9. I have given my and my parents most recent contact details (phone, email). In case of any change I undertake to inform college accordingly.
10. I hereby give my consent for use of my contact details for educational communication.
11. I am aware that as per University Circular No. SW/42 of 2015 dtd. 29th Oct. 2015, I am compulsorily required to give an undertaking on
www.antiragging.in & www.amanmovement.org.
12. I will get myself enrolled for Voter ID Card when I would turn 18 Years of age.
13. I am aware that if eligible for Scholarship / Freeship scheme of Social Welfare Department then I must complete all formalities in time. If I fail to do
so then I undertake to pay full fees of course by end of October of the Current Academic year.
14. If students have ATKT in FY & SY, then this students not eligible for TY. In case this circumstances students get admission then this students
admission cancel by college & and student responsible for that.

Date: 22-05-2019

(Signature of the Student)

DECLARATION BY STUDENT
1. I hereby declare that I have read all the rules and regulations framed by the college authorities as given in the college prospectus, which are presently
in force.
2. I hereby declare and undertake to abide by all the mentioned rules and regulations and hereby agree, if admitted, to confirm to them and to such other
rules as may hereafter be made for the smooth functioning of the college.
3. I may not be granted terms or allowed to appear for the College / University Examination if my attendance in lectures and tutorials / practicals falls
short of 75%.
4. I may not be granted any concession in any matter, if I take up any employment during the course of my studies.
5. I hereby declare that I shall show satisfactory progress and maintain good conduct.
6. I hereby declare that I have not registered my name at any other institution for any other full time course.
7. I hereby declare that the information filled in by me in this form is accurate and true to the best of my knowledge I will be responsible for any
discrepancy, arising out of the form signed by me and I undertake that, in absence of any document the final admission will not be granted and / or
admission will stand cancelled.
 8. I WILL DISPLAY MY IDENTITY CARD PROMINENTLY IN THE COLLEGE PREMISES.
9. I have given my and my parents most recent contact details (phone, email). In case of any change I undertake to inform college accordingly.
10. I hereby give my consent for use of my contact details for educational communication.
11. I am aware that as per University Circular No. SW/42 of 2015 dtd. 29th Oct. 2015, I am compulsorily required to give an undertaking on
www.antiragging.in & www.amanmovement.org.
12. I will get myself enrolled for Voter ID Card when I would turn 18 Years of age.
13. I am aware that if eligible for Scholarship / Freeship scheme of Social Welfare Department then I must complete all formalities in time. If I fail to do
so then I undertake to pay full fees of course by end of October of the Current Academic year.
14. I have read eligibility conditions of University of Mumbai for my course. My admission will be confirmed subject to confirmation from University of
Mumbai

Date:

(Signature of the Student)

DECLARATION BY PARENT / GUARDIAN

I have permitted my son / daughter / ward to join your college. The information supplied by him / her is correct to the best of my knowledge. I have acquainted
myself with the rules and fees, dues of my son / daughter / ward and to see that he / she observes, the said rules in totality. I hereby give my consent for use
of my contact details for educational communication.
Date: 22-05-2019

(Signature of the Parent / Guardian)

UNDERTAKING BY THE APPLICANT AND PARENT / GUARDIAN

1. We are aware that, as per University of Mumbai Rules and Regulations, overall 75% & not less than 50% attendance in any of the courses in each
semester is compulsory. If my ward fails to achieve the required attendance, the College authorities shall not accept his/her examination form/shall
not issue the Hall Ticket/ shall not allow him/her to appear in the corresponding Semester Examination.
2. We further, assure you of my ward’s good and orderly conduct as a student of this College. My ward will not defame or be a cause of damage to the
name of the College and any College property. If found guilty, I/my ward will abide by the decisions of the Discipline Committee, Principal and
Management of Royal College.
3. We assure you that my ward will not involve himself / herself in any political activity or any activity which would disturb the peaceful atmosphere
within the College campus.
4. We are aware of the Maharashtra Prohibition of Ragging Act 1999 and I state that my ward will abide by all the rules & regulations of the said Act.

Date: 22-05-2019 (Signature of Parents/Guardian) (Signature of Student)

NOTE: ATTACH THE PHOTOCOPY OF THE FOLLOWING DOCUMENTS AND CERTIFICATES

1. X Marksheet.
2. XII Marksheet.
3. For S.Y. Admission - Marksheet of F.Y. Sem I & Sem II.
4. For T.Y. Admission - Marksheet of F.Y. Sem I & Sem II and S.Y. Sem III & Sem IV.
5. Caste Certificate & Caste Validity Certificate (if any).
6. Address Proof (Aadhar Card / Passport / Electricity Bill / Telephone Bill)