Vidya Bhavan College of Management &

Research, Yavatmal
Run by - Aadhar Bahu-Uddeshiya Sanstha, Yavatmal
Sant Gadge Baba Amravati University Maharashtra India
Website : https://vbcmr.in/

Address : Dhamangaon Road, Yavatmal Phone : +91-8669567688

APPLICANT UNDERTAKING FORM (2022-2023)

To,
The Principal
Vidya Bhavan College of Management & Research, Yavatmal
Respected Sir/Madam,

"I SANJIVANI SHRIRAM GHULE (Application No. 0000000901) admitting to Vidya Bhavan
College of Management & Research, Yavatmal college in BCA PART II for academic
session 2022-2023.
Due to some personal reason if I have to cancel my admission then I have liable to pay all
fees mention in below table of my academic session 2022-2023.
Mobile No. (Self)
Registration
College Fee Total Fee (Payable Amount) Authorized Signatory 9834740825
Fee
15900 1500 17400 Mobile No. (Parent)
9834740825
If I have not paid the full fee, I will not take any objection even if my document is not
returned by the college. Adhar No.
Admission User ID 471864187419@bca2.2022_2023 471864187419
_______________
(Student Signatory)

* DOCUMENT ATTACHMENT (2022-2023) *

Document Name Original Document Xerox Document
SSC(10th)

HSC(12th)

Transfer Certificate (TC)

Cast Certificate

Non Criminal Certificate

Cast Validity Certificate

Adhar Card

Passport Photo

First Year (SEM I) __________

First Year (SEM II) __________

Second Year (SEM III) __________

Second Year (SEM IV) __________

Third Year (SEM V) __________

Third Year (SEM VI) __________

(Admission Incharge Signature)

(Student Signature)
( Authorized Signatory )
SANJIVANI SHRIRAM GHULE
()
Date 2022-07-22 09:09:12