7/27/2020

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Mithibai College of Arts, Chauhan Institute of Science and Amrutben Jivanlal College Application
of Commerce And Economics (132)
Bhakti Vedant Marg, Vile Parle West Mumbai No :
University of Mumbai
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
935805
Academic Year: 2020-2021 Regular
APPLICATION FORM

Course Applied for : B.A.(Autonomous)(with Credits) - Regular - CBCS - F.Y. B.A. Sem I (10001) PRN:
Application Date : 26/07/2020
1.Personal Information

Candidate's Name(Regional) : आईबारा अनोश बिजॅस

Candidate's Name as printed on Mark AIBARA ANOSH BURJIS

sheet : [*This name will appear on all University records/documents]
Father's/Husband's Name : BURJIS AIBARA Mother's Name : ALOO
Marital Status : UnMarried Mother Tongue : Gujarati
Place Of Birth : Mumbai Gender : Male Date of Birth (DD/MM/YYYY) : 18/11/2002
Blood Group : BPositive Religion : Parsi Country of Citizenship : India
Height : Not Available Weight : Not Available Hemoglobin : Not Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
State : Maharashtra District : Mumbai Suburban Tehsil : Andheri City/Town/Village : Mumbai Location Area : Urban
Address (House
Ramya Kunj, 3Rd Floor, Golibar Road No.2, Santacruz (East) Mumbai Pin Code : 400055
no,street/area/suburb etc.) :
Permanent Address :
State : Maharashtra District : Mumbai Suburban Tehsil : Andheri City/Town/Village : Mumbai Location Area : Urban
Address : Ramya Kunj, 3Rd Floor, Golibar Road No.2, Santacruz (East) Mumbai Pin Code : 400055
Contact details
Mobile Number 9867911048 Email ID: anoshaibara65@gmail.com
2.Legal Reservation Information
Category Type : Open Category : GEN
Is Specially Abled? No
3.Social Information(Additional Inforamtion)

Paper Selected for:

Sem I
BA10001 - B.A.(Autonomous) BA10002 - B.A.(Autonomous)
BA10003 - B.A.(Autonomous) BA10004 - B.A.(Autonomous)
Sem II

BA20001 - B.A.(Autonomous) BA20002 - B.A.(Autonomous)

BA20003 - B.A.(Autonomous) BA20004 - B.A.(Autonomous)

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Service Annual Income of Guardian : 1200000
5.Educational Details

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Month
Name of Name of Board/University and State of Name of Exam Certificate Mark
and Year Out of CGPA %
Examination University School/College Seat No. No. Obtained
of Passing
SMT
COUNCIL FOR THE INDIAN SCHOOL
LILAVATIBAI
Std 10th CERTIFICATE May 2018 6615675 tf20044905 542.00 600.00 -- - -- 90.33
PODAR HIGH
EXAMINATIONS,Maharashtra
SCHOOL
MAHARASHTRA STATE BOARD OF
Std 12th MITHIBAI
SECONDARY AND HIGHER July 2020 m268004 -- 580.00 650.00 -- - -- 89.23
Commerce COLLEGE
SECONDARY EDUCATION,Maharashtra
Your Last Qualifying Exam: HSC/Std 12th [Commerce]
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Passing Certificate of Std 12th / Statement of Marks of Std 12th OR Original Passing Certificate /Statement of Marks of Last Qualifying Exam like
degree,diploma,etc.

DECLARATION
I hereby declare that all the information furnished by me in this application form is true, complete and correct to the best of my knowledge and belief. I do
understand that I need to obtain and produce all the required documents. I Application No :935805 admit to having understood what constitutes ragging
and sexual harassment. I have read the guidelines related to the same. I hereby affirm that if found guilty of ragging or sexual harassment I am liable for
punishment according to the university regulations.

Place : Date :
( Signature of the Candidate )
For College/Institute/Study Center Use Only
Designation Remarks / Particulars / Recommendations Signature and Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: INR Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Mon Jul 27 2020 18:59:57 GMT+0530 (India Standard Time)

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