Application form Printout

Form No.: 1470926

Year of admission 2023-2024
Online Govt Application No.: MU232178254
Stream: Science - Unaided

Durgadevi Saraf Junior College

RSET Campus, S.V. Road, Malad West,
Mumbai-400064
Tel:4520 7755, - Email:info@dsjc.org.in

All Admissions are PROVISIONAL subject to confirmation of Maharashtra State Board of Secondary and Higher Secondary Education Admission to F.Y.J.C
Science

SC/ST Handicapped DT/NT Sports OBC/SBC

Freedom Fighter Ex-Serviceman Out of State Open Hindi Linguistic Minority

The Principal, Respected Madam / Sir,

Rajasthani Sammelan's, At the desire of my parents / guardian I wish to apply for admission to F.Y.J.C Science in your College. I have read the
Durgadevi Saraf Junior College rules and regulations. I promise to confirm to all the rules and regulations as may be framed from time to time for the
(Arts, Science & Commerce), smooth and efficient working of the college.
Mumbai.
1. Personal Information
Surname: Pal Name: Beauty Father's Name: Uma Mother's Name: Sunita
Date of
12-06-2008 Age: 15 year Place of Birth: Chillupur District Of Birth: Azamgarh
Birth:(Date)
State Of Birth: Uttar Pradesh Gender: Female Marital Status: Unmarried Nationality: Indian
Religion: HINDUISM Community HINDU Mother Tongue: Hindi Blood Group: A+
Religious Minority
Caste: HINDU Sub-Caste: open Reserve Category: OPEN No
Community:
Hindi speaking
Yes Landline No.: Mobile No.: 8652855157 Aadhaar No.: 355285584511
linguistic minority:
Email: khushboopal0745@gmail.com
Local Address: 165 jalim pal chawl Appa pada Malad east Mumbai-400097
Native Place
165 jalim pal chawl Appa pada Malad east Mumbai-400097
Address:
2. Father Detail
Name: Uma , , Qualification: 8TH PASS , Occupation: SELF EMPLOYED , Annual Income: 100000 , Tel No.: , Mobile: 9930047894 , Email Id: umapal0745@gmail.com ,
Address: 165 jalim pal chawl appa pada Malad East
3. Mother Detail
Name: Sunita , , Qualification: HSC , Occupation: HOUSEWIFE , Annual Income: , Tel No.: , Mobile: 8928678729 , Email Id: , Address: 165 jalim pal chawl appa pada
Malad East
4. Education Detail
Month of Year of Marks Out
Name of Examination Board: School / College: Class: Seat No: Marks Obtained: Percentage:
Passing: Passing: Of:
Mumbai Shivaji Vidya Mandir
Std. 10th 80%,81%,83% A278017 March 2023 334 500 66.80%
University High School
5. Attached Documents and Certificates (Original + 2 Xerox)
1. Statement Of Marks Std.10th 2. Leaving Certificate of Std.10th 3. Certificate of Caste With Category 4. Certificate for Physical Challended 5. Provisional Statement of
Eligibility 6. Passing Certificate of Std.10th 7. Migration Certificate
6. I wish to offer the following subject
A) Compulsory Papers:
1. English 2. Mathematics / Geography 3. Physics 4. Chemistry 5. Biology 6. Environmental Studies
A) Compulsory Papers:
1. English 2. Economics 3. Book Keeping & Accountancy 4. Organization of Commerce 5. Environmental Studies
b) Any one of the following
Hindi
Information Technology
I am applying for admission to the F.Y.J.C Science Class. I have given above all the particulars required. I further declare that i have not registered myself at any other
college or institute for any other course of study prescribed by the Maharashtra Board nor have I applied to any other collge / institute for F.Y.J.C. I understand that issuing
of this applicantion form and / or its submission to the college office, after it is duly completed by me, is no guatrantee that i will get admission.
DECLARATION /UNDERTAKING FROM THE STUDENT : I agree that I will not confirm my admission to any other college, I will submit my all original documents to the
college whenever required to do so, I am aware that if information in my admission form is found to be wrong and/or if it is known that I have submitted my original
document to any other college, my admission will be treated as cancelled and fees will not be refunded.

Date: Name & Signature of the Parent / Guardian Name & Signature of the Student
7. For Office Use Only
Checked By Receipt __________________________ & Date _____________________________ Receiver's Signature _______________________________

RECEIPT
Science - Unaided
Receipt No: 1470926
Name: Pal Beauty Uma

Category / Open / Minority / In-house / Reserved 334

Marks out off 66.80%
_______________________________________ 500