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    1st Minority

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    Varun Nair
    Dcunha Ilwin Ivan Jolly has applied for admission to the first year of a four-year engineering degree program for the 2011-2012 academic year under the minority quota. He provides his personal details including name, date of birth, addresses, contact information, and family details. His academic qualifications including scores from the MHT-CET exam, HSC exam, and SSC exam are also listed. He declares that the information provided is true and understands that any false information could result in cancellation of his admission. His parent also signs to agree to pay any fees and abide by the college and university rules. A list of required documents to be attached is provided.

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    1st Minority

    Uploaded by

    Varun Nair
    51 views3 pages
    Dcunha Ilwin Ivan Jolly has applied for admission to the first year of a four-year engineering degree program for the 2011-2012 academic year under the minority quota. He provides his personal details including name, date of birth, addresses, contact information, and family details. His academic qualifications including scores from the MHT-CET exam, HSC exam, and SSC exam are also listed. He declares that the information provided is true and understands that any false information could result in cancellation of his admission. His parent also signs to agree to pay any fees and abide by the college and university rules. A list of required documents to be attached is provided.

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    1st Minority(2)

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    Dcunha Ilwin Ivan Jolly has applied for admission to the first year of a four-year engineering degree program for the 2011-2012 academic year under the minority quota. He provides his personal details including name, date of birth, addresses, contact information, and family details. His academic qualifications including scores from the MHT-CET exam, HSC exam, and SSC exam are also listed. He declares that the information provided is true and understands that any false information could result in cancellation of his admission. His parent also signs to agree to pay any fees and abide by the college and university rules. A list of required documents to be attached is provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    51 views3 pages

    1st Minority

    Uploaded by

    Varun Nair
    Dcunha Ilwin Ivan Jolly has applied for admission to the first year of a four-year engineering degree program for the 2011-2012 academic year under the minority quota. He provides his personal details including name, date of birth, addresses, contact information, and family details. His academic qualifications including scores from the MHT-CET exam, HSC exam, and SSC exam are also listed. He declares that the information provided is true and understands that any false information could result in cancellation of his admission. His parent also signs to agree to pay any fees and abide by the college and university rules. A list of required documents to be attached is provided.

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    of 3

    ADMISSION FORM

    FORM NO : 69

    APPLICATION FOR ADMISSION TO FIRST YEAR OF FOUR YEAR FULL-TIME DEGREE COURSE IN ENGINEERING FOR THE ACADEMIC YEAR 2011-12 FOR MINORITY QUOTA

    Name of the Candidate :

    DCUNHA ILWIN IVAN JOLLY

    PERSONAL DETAILS
    Gender Date of Birth E-mail Telephone no Mobile no Catholic : Male : 1991-01-24 : www.joslyn.iann@yahoo.co.in : 28801420 : 2147483647 : Yes PASTE PHOTO HERE

    Address for Correspondence:


    Address City / State Country / Pin : MUMBAI / Maharashtra : India / 400064

    Permanent Address:
    : 207 C-WING ADARSH AP ADAARSH ROAD MALAD(W : MUMBAI / Maharashtra : India / 400064 City / State Country / Pin

    : 207 C-WING ADARSH AP ADAARSH ROAD MALAD(W Address

    Parents / Guardians Details:


    Name Phone Mobile / E-mail Qualification: Occupation: : RITA DCUNHA : 28089691 : 2147483647 / www.joslyn.iann@yahoo.co.in : B.COM : BUSINESS

    Company Name
    Address City / State Country / Pin

    : 207 C-WING ADARSH APARTMENT ADARSH ROAD


    : 207 C-WING ADARSH AP ADAARSH ROAD MALAD(W : MUMBAI / Maharashtra : India / 400064

    Designation / Income : - / 3,50,0000

    ACADEMIC DETAILS

    MHT-CET Seat Number MM311

    MHT-CET Merit No 40678

    AIEEE Rank -

    AIEEE Marks 0

    Physics CET 14

    Chemistry 29

    Maths 42

    Total 85

    Physics HSC STD 12th. 70

    Chemistry 71

    Maths 67

    Aggregate 403

    Out of Marks 600

    HSC Percentage 67.17

    Science SSC 86

    Maths 42

    Aggregate 493

    Out of Marks 650

    SSC Percentage 75.85

    LAST COLLEGE ATTENDED : ST. ANNES JR COLLEGE STD 10TH BOARD STD 12TH BOARD : SSC : HSC

    DECLARATION : The information given by me in my application is true to the best of my knowledge and belief.I understand that if any of the statements made by me in the application form or any information supplied by me in connection with my admission is, at any time found to be false or incorrect, my admission will be , cancelled admission will be cancelled, fees forfeited and I may be expelled from the college by the Principal Date :

    Place :

    Signature of Candidate

    Signature of Parent

    UNDERTAKINGS

    Declaration to be signed by the candidate: The information given by me in my application is true to the best of my knowledge and belief.I understand that if any of the statements made by me in the application form or any information supplied by me in connection with my admission is late on at any time , found to be false or incorrect, my admission will be cancelled,fees forfeited and i may be expelled from the college by the Principal.I have not been debarred anytime from appearing at any examination held by the Government constituted or statutory examination authority in India. I shall abide by the rules imposed by the university from time to time such as imposing limit in the number of attempts permisssible to pass any examination. I hereby agree to conform to any rules, acts and laws enforced by government and I hereby undertake that,I will do nothing either inside or outside the college which may result in disciplinary action against me under these rules, acts and laws referred to. I fully understand that the Principal of the college has a right to expel me from the college for any infrigement of the rules of conduct and discipline prescribed by the college or University or Government and the undertaking given above. Condition of minimum attendance: I am fully aware that, I will not be allowed to appear for the examination if I do not attend the minimum of 75 percent classes of theory, practical drawings etc. I am also aware that I will, not be allowed to appear for the examination , if I fail to submit satisfactorily all the assignments,jobs, journals, drawings, and reports as specified by the University within stipulated time limit.

    Place: Date: Signature of the Candidate

    Declaration to be signed by the Parent / Guardian I,Mr. /Ms. ______________________________________________________________________________________ father / mother / guardian of Mr. / Ms. _______________________________________________________________ declare that the particulars furnished to by my son / duaghter / ward such fees , charges etc. which the Government of Maharashtra/ University of Mumbai may levy from time to time by due date I also undertake and to pay any differences in the fees which may occur due to revision in fee structure any time during the academic year 2010-11 and in the event of failure on my part and / or on the part of my son/ daughter/ ward to do so, suitable action as the college may deem fit be taken against him / her.

    Place: Date: Signature of the Parent/Guardian

    ATTACHMENTS

    List of copies of Certificates to be attached with the application form: All copies must be attested

    For office use S-SUBMITTED X-NOT SUBMITTED

    1. Proof of Roman Catholic Minority Status. a) Baptism Certificate b) Letter from Bishop c) Affidavit from the ourt on Rs. 100 Stamp paper 2. Marksheet of qualifying examination(std. XII). 3. Marksheet of Std.10th examination. 4. MHT-CET-2011/AIEE 2011 Score Card 5. College Leaving certificate from the institution from which candidate passed qualifying exam or from the institute last attended 6. Physical Fitness Certificate from the institution from a Medical Practioner (specific mention of ability to handle manual work) 7. Certificate of Indian Nationality & Domicile 8. Eligibility certificate from Universityi(In case of candidate who passed qualifying. examination from outside Maharashtra,CBSE or ICSE). 9. Migration Certificate and Passing Certificate(In case of candidate. who passed qualifying examination from outside Maharashtra,CBSE or ICSE).

    Total number of attested Certificate copies submitted: Please do not attach certificates,which are not asked for. Incomplete forms will not be accepted.

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