8/3/2019 22322

1/3

NoMaritial Status

Dhangar (29)Caste Sub Caste

NoIs Applicant

Salaried ?

0.00Applicant's Annual

Income

25000.00Total Annual

Income

B.Sc(C.S.) 2011 69

Mahatama Jyotiba Phule College of Comp.Sci.& Information Technology,Chousala Tq.Di

Last Exam MarksLast Exam Passed

Year

Last attended School/College/Institute

Last Exam

Passed

Master of Business Administration

2011-2012

05-08-2011 06-08-2011

Government Quota

NoIs Fees Paid ?

Quota

Academic Year

Joining DateDate Of

Admission

Subject

Course Name

first name middle name last name

C107589SSC Seat No

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATIONSSC Board

2004Passing Year

Fee Receipt No.

Fee Receipt Date

59.46SSC Marks Obtained

Student SSC Details

Applicant's Details

NoOr han

YesHas Applied For

Hostel ?

Please

Paste

Pasport Size

Photograph

Student Prequalifying Details

Institution Details

2011-2012Academic Year

05/08/2011College Admission

Number

Application Form

Vimukta Jat Nomadic TribesCaste Category

Appilcation type New

04-10-2011Application Date

Applicant Name ANIL MANOHAR MARKAD AsrabaiMother's Name

Is Resident of

Maharashtra

Maharashtra25-06-1988Date of Birth Gender Male

Name of School/College/Institute where

Admitted

Rajarshi Shahu Institute of Management, Aurangabad - 431210

Is Staying at

Hostel ?

No

Disabilit T e

Fee Paid

Course Year

Passed

0.00

1

Yes

N.A.Is Disabled No

N.ARenewal Course Year

Is Admission after

Di loma

No

APPC1075891M20042011Application Number

8/3/2019 22322

2/3

Residential Number: N.A, MobileNumber: 8390138912, EmailAddress: Anil.mmarkad@rediffmail.com

Address:- At.Tartewadi Post.Shirasmarg Tq.Georai Dist.Beed Location:- Tartewadi City:- Shirasmarg

Pincode:- 431127 Taluka:- Georai District:- Beed

ScrutinyCommittee No

Dec.No.C.Dec./B-334

Parent

Age

47

Issued in 2011

AurangabadDistrict IssuingOffice

Taluka Issuing

Office

GeoraiCaste Certificate

No

Income Certificate

No

Caste ValidityCertificate No

No.D 6274

No.2002/Misc/CR/1

54

District Issuing

Office

Beed

IN-739

University

Re istration No

Document Details

Is Studying in night

school

No

Hostel/ Landlord

Address

N.A Hostel/Landlord

Contact Details

N.A

Hostel Admission

Date

N.AName of Landlord /

Hostel

N.A

N.A Is Mess Service

Available?Rent Per MonthNoHostel Type

Hostel Information

Parmanent Address At.Tartewadi Post.Shirasmarg Tq.Georai Dist.Beed

Parent's nameMANOHAR

middle name

KISANRAO

last name

MARKAD

Relation with

Applicant

Father Profession

Parents Annual

Income

25000.00

Farmer

first name

(yrs)

Parent / Guardian Details

Address For Correspondence

Contact Details

Student Bank Account Details

STATE BANK OF HYDERABAD

GEORAIBranch Name

62165995531Bank Account NoBank Name

8/3/2019 22322

3/3

Document Attached

Applicant Parent's SignatureApplicant's Signature

The information furnished by me is complete and correct. I bear the complete responsibility for all the above information.

Principal's Signature

Declaration

Caste Certificate Issued by Competant Officer

Income Proof - Income Certificate Issued by Competant Authority

Marksheets

I-card Size Photo

Caste Validity Certificate

District Transfer Certificate

Non-Crimiliar Certificate