Session 2019-2020 YASHWANTRAO CHAVAN COLLEGE College Code :YCCH Halkarni,Tal Chandgad, Dist Kolhapur For College Course Admitted to: B.Sc. - 1 Registration No. use only 481544 Admission Date : 01. Personal Information Section LAST NAME FIRST NAME MIDDLE NAME Name of the Student SHENDE PRASHANT ANAPPA Father's Name SHENDE ANAPPA Mother's Name : MANGAL Marital Status : Married Saral No. : Date of Birth : 26/11/1983 Gender : Male Place of Birth : KAROSHI Blood Group : A+ Grandfather Name : Native Place : GADHINGLAJ Voter ID Card No. : JTX5262321 Organ Donar : NO Medium : ENGLISH Bank Name : BANK OF INDIA Account No. : 092610110004322 Transaction Type : OFFLINE Religion : HINDU Citizen of : INDIAN UDISE No. : Aadhar Card No. : 411414141412 Driving Licence No. : Minority: NO 02. Address Details Patil Colony, Sankeshwar Road,Behind Hotel Saiplaza, Gadhinglaj. Address for Correspondence: Pin Code : 416502 State : MAHARASHTRA District : KOLHPUR Tehsil : GADHINGLAJ City : GADHINGLAJ Patil Colony, Sankeshwar Road,Behind Hotel Saiplaza, Gadhinglaj. Permanent Address Pin Code : 416502 State : MAHARASHTRA District : KOLHPUR Tehsil : GADHINGLAJ City : GADHINGLAJ 03. Contact Details Student Phone : Parent Phone : 9156226868 Student Mobile No.: 9403106868 Student Email Id: [email protected] 04. Legal Reservation Information Section Domicile State : KARNATAKA Type Of Category : General Caste Category : OPEN SubCaste : MARTATHA Phy. Handicapped : Caste Certificate No. : Learning Disability No. : 05. Social Reservation (Special Category) Information Section SR NO. SOCIAL RESERVATION NAME 1 06. Education Details Section Passing Grade / CGPA Name of Name of Name of School Date of Examination Obt Certificate No. Total % Examination Board / College Passing Seat No. Marks Marks 07. Qualifying Exam Details Section Qualifying Exam Name : HSC College/School Board/ Admission Passing Marks Total Percentage Place Arts/Com Education Attended University Year Year Obt Marks /Sci Gap SAMBHAJIRAO MANE JR 0 0 560 700 80.00 NO COLLEGE GADHINGLAJ Qualifying Exam Subject Details Sr.No. Subject Name Total Marks Obtained Marks 1 08. Subject Details Section Preferenace : 1 Group Name : GROUP A STATSTICS STATSTICS English English PHYSICS PHYSICS CHEMISTRY CHEMISTRY MATHEMATICS MATHEMATICS English English PHYSICS PHYSICS CHEMISTRY CHEMISTRY STATSTICS STATSTICS MATHEMATICS MATHEMATICS 09. Attached Documents Sr No. Name of Documents/Certificates 1 10. Guardian / Parent Information Section Guardian's/ Parent's Name : Occupation of the Guardian/Parent : Annual Income of the guardian/Parent : 200,000.00 Relationship of Guardian with applicant : SON Guardian/Parent Phone No. : 9156226868 11. Other Information Section Mother Tongue : MARATHI Employment Status : NO Do you wish to join NCC / NSS: NO Would you like to apply for Hostel : NO Hobbies, Proficiency and Other interests : READING TRACKING Games and sports participation : Personal Identification Marks : -- 12. Declaration by Student I hereby declare that, I have read the rules related to admission and the information filled in by me in this form is accurate and true to the best of my knowledge. I will be responsible for any discrepancy, arising out of the form signed by me and I undertake that, in absence of any document the final admission will not be granted and / or admission will stand cancel. Place : Date : Signature of the Student: 13. Declaration by Guardian / Parent I have permitted my son / daughter / ward to join your college.The information supplied by him / her is correct to the best of my knowledge. I have acquainted myself with the rules and fees, dues to my son / daughter / ward and see that he / she observes. Place : Date : Signature of the Guardian/Parent: 14. For College / Institute Use Only Designation Remarks / Particulars /Recommendations Signature and Date Admission Clerk Admission Committee Accountant / cashier Registrar/Office Cash Received : Rs 0.00 superintendent REMARK OF THE ADMISSION COMMITTEE May be admitted to Class_____________________________________________________ Section__________________ May be Rejected____________________________________________________________________________________ Last date of payment of fees __________________________________________________________________________ Admission may be canceled if the fees are not paid by this date. Principal Signature of Admission Committee.