STUDENT COPY

BHARTIYA JAIN SANGHATANA COLLEGE (62101)

Yashwantrao Chavan Maharashtra Open University Application No :

Dnyangangotri Near Gangapur Dam, Nashik, Pin Code-422222, Maharashtra(India)
Academic Year: 2021-2022
402117
Distance Education
YCMOU Study Center Submission Slip
ADMISSION FORM
Instruction:
Please submit copy of this submission slip with following list of document to Study Center for Recommendation of
Program for Admission and/or Recommendation of Scholarship.
Please note that application shall be considered for admission only after recommendation by study center
If recommendation by study center not completed before last date of admission your application will be automatically
cancelled. Please note that university will not refund the fees in case of rejection by study center for want of Eligibility.

Course Applied for : B.A.(with Credits) - Distance Education - 2000 Pattern - T.Y. B.A. (G01) PRN:2019017002267562
Application Date : 15/09/2021 Payment Category : 8
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
MOMIN SHAIN NAJIR
Candidate's Name as printed on
[*This name will appear on all University
School leaving/Passing Certificate :
records/documents]
Father's/Husband's Name : NAJIR MOMIN Mother's Name : SAYARA
Marital Status : Married Mother Tongue :
Place Of Birth : Ghodegaon Gender : Female Date of Birth (DD/MM/YYYY) : 22/02/1991
Blood Group : Religion : Country of Citizenship : India
Weight : Not
Height : Not Available Hemoglobin : Not Available
Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Tehsil : PUNE City/Town/Village :
Available
Address (House
no,street/area/suburb ADITYA PARK NEAR BAGICHA HOTEL KOREGAON BHIMA Pin Code : 412216
etc.) :
Contact details
Mobile
918208673374 Primary Email ID: mominshain1@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : GEN
Open
Is Specially Abled? No
3.Social Information(Additional Inforamtion)

Paper Selected for:

T.Y. B.A.
HIN260 - Kavita : Swaroop Aur Vivechan HIN262 - Hindimain Navjagaran
HIN264 - Prayojanmulak Hindi ECO275 - Bharatacha Aarthik Vikas
ECO276 - Sarvajanik Vittavyavhar ECO279 - Grahak Saurakshan

Medium of Instruction : Marathi

Admission Fee Payment
Fee Category : Regular Fees Over All Payment Status: : Paid
Details
Adm Exam Fee - 750 Tution Fee - 400
Registration Fee - 100 Development Fund Fee - 150
Other Fee - 200 Total : 1600
Payment
Installment Amount Transaction Date Transaction Number Transaction Type
Status
1 800 Paid 15/09/2021 00:00:00 2898291631745821459 Online Payment
2 800 Paid 28/09/2021 07:43:02 2898291632858182896 Online Payment
4.Guardian Information
Occupation of Guardian : Business Annual Income of Guardian : 50000
5.Educational Details
Month and Exam
Name of Name of Board/University and Name of Certificate Mark Out
Year of Seat CGPA %
Examination State of University School/College No. Obtained Of
Passing No.
MAHARASHTRA STATE BOARD
March
Std 10th OF SECONDARY AND HIGHER -- -- 403.00 650.00 -- - -- 62.00
2007
SECONDARY EDUCATION,
MAHARASHTRA STATE BOARD
Std 12th 12Th February
OF SECONDARY AND HIGHER -- -- 394.00 600.00 -- - -- 65.67
(Arts) 2009
SECONDARY EDUCATION,
Your Last Qualifying Exam:
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Statement of Marks of Qualifying Exam (पा ता परी ेची गुण प का)

Passing Certificate of Std 10th.

Passing Certificate of Std 12th / Statement of Marks of Std 12th.

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 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 )
[STUDY CENTER COPY]

BHARTIYA JAIN SANGHATANA COLLEGE (62101)

Yashwantrao Chavan Maharashtra Open University

Application No :
Dnyangangotri Near Gangapur Dam, Nashik, Pin Code-422222, Maharashtra(India)
Academic Year: 2021-2022
402117
Distance Education
YCMOU Study Center Submission Slip
ADMISSION FORM
Instruction:
Please submit copy of this submission slip with following list of document to Study Center for Recommendation of
Program for Admission and/or Recommendation of Scholarship.
Please note that application shall be considered for admission only after recommendation by study center
If recommendation by study center not completed before last date of admission your application will be automatically
cancelled. Please note that university will not refund the fees in case of rejection by study center for want of Eligibility.

Course Applied for : B.A.(with Credits) - Distance Education - 2000 Pattern - T.Y. B.A. (G01) PRN:2019017002267562
Application Date : 15/09/2021 Payment Category : 8
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
MOMIN SHAIN NAJIR
Candidate's Name as printed on
[*This name will appear on all University
School leaving/Passing Certificate :
records/documents]
Father's/Husband's Name : NAJIR MOMIN Mother's Name : SAYARA
Marital Status : Married Mother Tongue :
Place Of Birth : Ghodegaon Gender : Female Date of Birth (DD/MM/YYYY) : 22/02/1991
Blood Group : Religion : Country of Citizenship : India
Weight : Not
Height : Not Available Hemoglobin : Not Available
Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Tehsil : PUNE City/Town/Village :
Available
Address (House
no,street/area/suburb ADITYA PARK NEAR BAGICHA HOTEL KOREGAON BHIMA Pin Code : 412216
etc.) :
Contact details
Mobile
918208673374 Primary Email ID: mominshain1@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : GEN
Open
Is Specially Abled? No
3.Social Information(Additional Inforamtion)

Paper Selected for:

T.Y. B.A.
HIN260 - Kavita : Swaroop Aur Vivechan HIN262 - Hindimain Navjagaran
HIN264 - Prayojanmulak Hindi ECO275 - Bharatacha Aarthik Vikas
ECO276 - Sarvajanik Vittavyavhar ECO279 - Grahak Saurakshan

Medium of Instruction : Marathi

Admission Fee Payment
Fee Category : Regular Fees Over All Payment Status: : Paid
Details
Adm Exam Fee - 750 Tution Fee - 400
Registration Fee - 100 Development Fund Fee - 150
Other Fee - 200 Total : 1600
Payment
Installment Amount Transaction Date Transaction Number Transaction Type
Status
1 800 Paid 15/09/2021 00:00:00 2898291631745821459 Online Payment
2 800 Paid 28/09/2021 07:43:02 2898291632858182896 Online Payment
4.Guardian Information
Occupation of Guardian : Business Annual Income of Guardian : 50000
5.Educational Details
Month and Exam
Name of Name of Board/University and Name of Certificate Mark Out
Year of Seat CGPA %
Examination State of University School/College No. Obtained Of
Passing No.
MAHARASHTRA STATE BOARD
March
Std 10th OF SECONDARY AND HIGHER -- -- 403.00 650.00 -- - -- 62.00
2007
SECONDARY EDUCATION,
MAHARASHTRA STATE BOARD
Std 12th 12Th February
OF SECONDARY AND HIGHER -- -- 394.00 600.00 -- - -- 65.67
(Arts) 2009
SECONDARY EDUCATION,
Your Last Qualifying Exam:
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Statement of Marks of Qualifying Exam (पा ता परी ेची गुण प का)

Passing Certificate of Std 10th.

Passing Certificate of Std 12th / Statement of Marks of Std 12th.

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 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 )
Document printed on Wed Sep 29 2021 14:45:27 GMT+0530 (India Standard Time)