DECLARATION CUM UNDERTAKING

FOR ADMISSION TO F.Y.J.C.

ACADEMIC YEAR 2020-21

I, Mr/Ms _______________________________________
Mobile No. - __________________________
Email Address –
________________________ here by declare that
information in admission form are correct.
I am confirming my F.Y.J.C. – (Arts/Commerce/Science)
admission for _________________________ Category at
Mithibai Junior College, Vile Parle (W) for academic year
2020-21.
My registration number of Government Online
Application no., i.e. UID number is ______________
I am aware that if the information in my admission form
is found wrong, then my admission in your institution will be
liable for cancellation.
Date:
Place: Signature of student
Endorse and confirm the above undertaking given by my
ward.
Parent name:
Signature of parent/Guardian
 DOCUMENTS REQUIRED FOR CLAIMING GIRLS’ FREE SHIP

ONLY FOR GIRL STUDENTS CLAIMING FREE EDUCATION.

i) Declaration form
ii) Photocopy of the first and the last page of the ration card which includes
the name of the parent/guardian and the student. (Student should not be
the fourth child)

iii) Photocopy of Birth Certificate (Student should be born in Maharashtra)

OR
Parent’s service certificate indicating last 15 years’ stay in
Maharashtra.
OR
Telephone Bills/Electricity bills/Rent receipt etc. which establishes
authentically that the parent is a resident of Maharashtra state for the last
15 years.

If the above criteria is not fulfilled at the time of admission, the girl student
will have to pay full fees in both STD. XI and XII which will not be
refunded.
 Mithibai College of Arts, Chauhan Institute of Science and
Amrutben Jivanlal College of Commerce & Economics
(Autonomous)
Vile Parle (West), Mumbai 400 056

UNDERTAKING TO SUBMIT AADHAAR CARD DETAILS

Admissions to FYJC class of 2020-21
This is for the students who do not have their Aadhaar Card at the time of
form filling.

Undertaking/ Self Declaration

Name of the student: - -------------------------------------------------------------------

Govt application form number:- -----------------------Category :- ----------------
Post application form number:- —————————————-
Merit number:- ————————————

I, under signed _____________________________________________________ do not have

Aadhar card to upload right now.

I, hereby, undertake to present the original Aadhaar Card as soon as possible.

I am aware that, if I fail to submit the same it may cause delay in internal
processing (SAP) as well as in submission of Students Data to the Education
Board for Registration and Promotion procedures in the near future. I shall
not hold the college administration responsible for any such unpleasant
outcome in the future due to my inability / delay in submission of Aadhaar
Card details / document.

Date-

-------------------------------------- ---------------------------------------
Student’s Signature and Name Parent’s Signature and Name
 Mithibai College of Arts, Chauhan Institute of Science and
Amrutben Jivanlal College of Commerce & Economics
(Autonomous)
Vile Parle (West), Mumbai 400 056
UNDERTAKING TO SUBMIT DOCUMENTS NECESSARY FOR ADMISSION
TO BE CONFIRMED

Admissions to FYJC class of 2020-21

This is for the students who have not uploaded the required documents at
the time of form filling.

Undertaking/ Self Declaration

Name of the student: - -------------------------------------------------------------------

Govt application form number:- ------------------ Category :- --------------------
Post application form number:- --------------—————————————
Merit list number ———————————-

I, undersigned __________________________________________________________ do not

have following documents to upload right now.

(Please mention, NOT AVAILABLE against the document which is to be

submitted later).

Sr. No. Document Remark

1. Std.10th School L.C./Transfer Certificate
2. Divyang (Disability) Certificate
3. Project affected/ earthquake affected Certificate
4. Parent’s Transfer Order and Joining Report
5. Service Certificate or District Sainik Board
Certificate for Defence / Ex. Service Person
6. Sports Certificate
7. Orphan Certificate
8. Freedom Fighter Certificate
NB-If you have uploaded any certificate or its acknowledgement receipt,
please mention it in the Remarks column.

I, hereby, declare that, the entries made by me in the Application Forms

(both Govt. online & Mithibai College FYJC Post Application) are complete
and true to the best of my knowledge and based on factual records.

I, hereby, undertake to present the original documents within three months

of the confirmation of my admission to the concerned junior college.

I am aware that, if I fail to submit these original document(s) or if there is a

discrepancy between the information, I have given in the application form
and my original certificates, my admission shall stand cancelled with
immediate effect.

Date-

--------------------------------------------- ---------------------------------------------

Student’s Signature and Name Parent’s Signature and Name

 UNDERTAKING FOR GUJARATI LINGUISTIC MINORITY
Date : -

To,

The Principal

Mithibai College of Arts,

Chauhan Institute of Science and

Amrutben Jivanlale College of Commerce & Economics

(Autonomous)

Sub : - F.Y.J.C. Arts /Commerce/Science

Category: Gujarati Linguistic Minority

Sir,

I solemnly declare that I belong to the Category of Gujarati Linguistic Minority. If, however, the
information furnished by me in this regard is found to be incorrect at any stage, I understand that
my admission is liable to be cancelled.

Date: __________________

Student Parent / Guardian

Name ______________________________________ Name : -

_________________________________________

Signature__________________________________
Signature_________________________________

Address : - ________________________________

_____________________________________________

_____________________________________________

_____________________________________________

Tel : - _____________________________________

_____________________________________________

_______________________________________
DECLARATION (2020-21) (To be filled by female students only)

Name Roll No________Div____________

Form of declaration regarding free education to girls in Std XI & XII in recognized aided Junior college.

The Principal,
Mithibai College of Arts, Chauhan Insititute of Science
& Amrutben Jivanlal College of Commerce and
Economics. Vile Parle (West), Mumbai 400 056.

I, Shri/ Smt. _______________________________________________________________________ _

Parent /Guardian of the student mentioned herein seeking admission / studying in Std. shown against her /
their name (s) hereby declare that I am a resident of Maharashtra State for not less than 15 years (Photocopy
of * documentary evidence must be attached) and that my daughter who is seeking admission in your
college is not the fourth, or subsequent child etc. (See the note below)

No. Name of the child to be written in the order of date Date of Age Standard
of birth. birth(d/m/yr)
1

• I know that if this information is proved to be false, the concession of free education to my ward(s) will be
cancelled.
• Annual Income from All sources of Previous Year Rs. ____________________

Signature of Guardian / Local Guardian Name of the Student & Signature

Date _____________ Residential Address: ____________
_____________________________
_____________________________
Tel. No: _______________________

This information is true & verified, please approve the Girls Freeship concession to the student.
Date: __________________ ________________________________
Signature of Principal

1. Attach photo copies of the First and the Last page of your Ration Card wherein the name of the Parent /
Guardian and the child are mentioned. (Original Ration Card should be carried for verification)
*2.a) Birth Certificate of the student (if born in Maharashtra) or Parent's Service Certificate of last 15
years and Student’s Domicile Certificate b) Telephone Bills / Electricity Bills / Rent Receipt etc.
Telephone Bills/Electricity bills/Rent receipt etc. which establishes authentically that the parent is a
resident of Maharashtra state for the last 15 years.
 DOCUMENTS TO BE UPLOADED AS
GUJARATI LINGUISTIC MINORITY PROOF.

Photocopy of one of the following documents can be

uploaded as a proof for the candidate belonging to the
Gujarati Linguistic Minority Community.
• Mark Sheet/School Leaving Certificate indicating
Applicant/ father/ mother* having studied Gujarati as
one of the subjects.
(*In case of mother’s mark sheet, copy of marriage certificate
is required.)
OR
• A stamped letter on the letter head (with registration no.) of
the community Head /Secretary signed by the President
mentioning ‘<student’s name> belongs to a Gujarati Speaking
community’
OR
• Vasti -Patrak of the community wherein the name of the
applicant appears along with his/her parent’s name.