Admission Form

Submitted On: 26/06/2024 15:45 FormNo:9000221
Shikshak Sanchalit Shikshan Sanstha`s
DR. SHANTILAL DHANJI DEVSEY ARTS

COLLEGE & COMMERCE & SCIENCE
COLLEGE, WADA
ADMISSION FORM
F.Y.B.Sc. (NEP 2020) (2024-2025)
The Principal,
DR. SHANTILAL DHANJI DEVSEY ARTS
COLLEGE & COMMERCE & SCIENCE COLLEGE, WADA
At Post- Wada, District - Palghar, 421303
I wish to apply for admission to the F.Y.B.Sc. (NEP 2020) Class. I give below the necessary particulars.
Student Name THAKARE DASHRATH MADHUKAR

Mother`s Name MANDA
Aadhar Card 439019709200 Academic Bank of Credits 899428970812
Gender/Sex Male Marital Status Unmarried
Blood Group O+ Date Of Birth(As per LC) 05/04/1996
Place Of Birth (Village/City) VILSHET Nationality Indian
Mother Tongue Marathi Religion Hindu
Category ST Caste HINDU
SubCaste VARALI Physically Challenged N/A
Correspondence Address AT VILSHET POST SOMATA TALUKA VIKRAMGAD DIST PALGHAR
(Actual Place Of Stay)
Correspondence Pin Code 401403
Permanent Address AT VILSHET POST SOMATA TALUKA VIKRAMGAD DIST PALGHAR
Native District PALGHAR Native State Maharashtra
Rural/Urban(Native) Rural Telephone No.(Resi.) ----
Student Mobile No 8080597227 Student Email ID thakaredashrath17@gmail.com
Guardian Mobile No 9209589098 Guardian Email ID ----
Avail ST Concession: Yes Enrolled in Voter`s List? No
Subjects Offered
1. SEM I & II MAJOR- CHEMISTRY PHYSICS BOTANY 2. SEM I & II VSC- CHEMISTRY
3. SEM I & II SEC- MATHEMATICS 4. SEM I & II AEC- INTRODUCTION TO COMMUNICATION
SKILL-I
5. SEM I VEC- INDIAN CONSTITUTION 6. SEM I & II IKS- INDIAN KNOWLEDGE SYSTEM SERIES
(GENERIC) -I
7. SEM I & SEM II CC- SPORTS 8. SEM II OE- COMPLETE PREPARATION FOR COMPETITIVE
EXAM- ESSAY WRITING AND SUMMARY WRITING
FormNo:9000221
Examination Name of the Board / Mon. & Year Name of the College Seat No Total Marks Attempt Out of /
University of Passing /SGPA Grade
HSC Maharashtra State Board 2014-02 Wada College M030001 395 1 650
PARENT / GUARDIAN DETAILS

Parents/Guardian Name MADHUKAR GANPAT THAKAR Parents/Guardian Relationship FATHER
E
Parents/Guardian Occupation FARMER Parents/Guardian Office Add. AT VILSHET POST SOMATA T
AL VIKRAMGAD PALGHAR
Annual Income (In Figures) 25000.00
DECLARATION BY STUDENT
1. I hereby declare that I have read all the rules and regulations framed by the college authorities as given in the college prospectus, which are presently in force.
2. I hereby declare and undertake to abide by all the mentioned rules and regulations and hereby agree, if admitted, to confirm to them and to such other rules as may
hereafter be made for the smooth functioning of the college.

3. I may not be granted terms or allowed to appear for the College / University Examination if my attendance in lectures and tutorials / practicals falls short of 75%.
4. I may not be granted any concession in any matter, if I take up any employment during the course of my studies.
5. I hereby declare that I shall show satisfactory progress and maintain good conduct.
6. I hereby declare that I have not registered my name at any other institution for any other full time course.
7. I hereby declare that 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 cancelled.
8. I WILL DISPLAY MY IDENTITY CARD PROMINENTLY IN THE COLLEGE PREMISES.
9. I have given my and my parents most recent contact details (phone, email). In case of any change I undertake to inform college accordingly.
10. I hereby give my consent for use of my contact details for educational communication.
11. I am aware that as per University Circular No. SW/42 of 2015 dtd. 29th Oct. 2015, I am compulsorily required to give an undertaking on www.antiragging.in & www.
amanmovement.org.
12. I will get myself enrolled for Voter ID Card when I would turn 18 Years of age.
13. I am aware that if eligible for Scholarship / Freeship scheme of Social Welfare Department then I must complete all formalities in time. If I fail to do so then I
undertake to pay full fees of course by end of October of the Current Academic year.
14. I hereby promise to you that if Govt. of India Schloarship (Maintanence allowance & College fees) has been disbursed to my Saving A/c by concern party, I will
refund College Fees to College in time limit.
DECLARATION BY PARENT / GUARDIAN

1. I have permitted my son / daughter / ward to join your college.
2. The information supplied by him / her is correct to the best of my knowledge.
3. I have acquainted myself with the rules and fees, dues of my son / daughter / ward and to see that he / she observes, the said rules in totality.
FREESHIP / SCHLORSHIP NOTIFICATION

1. If you hold valid Caste Certificate and Income Certificate then you are eligible for Scholarship / Freeship from Government of Maharashtra.
2. Contact College Office in July to fill up the required form / online form.
3. If you do not fill up this form or incase your application of Scholarship / Freeship is rejected by concerned authorities you will have to pay FULL FEES by end of
October of the Current Academic Year.

4. In case you neglect this step the entire responsibility will be yours, please note.
5. In case of student wish to cancel admission before filling up of scholarship / freeship form, then he / she will have to pay fees of the course as per University of
Mumbai Rules and Regulaions from time to time.
(Signature of the Student) (Name & Signature of the Parent / Guardian)
FOR COLLEGE USE ONLY
Date Amount Receipt No.:
(Receiver Signature)

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Submitted On: 26/06/2024 15:45 FormNo:9000221

Shikshak Sanchalit Shikshan Sanstha`s

DR. SHANTILAL DHANJI DEVSEY ARTS

Student Name THAKARE DASHRATH MADHUKAR

PARENT / GUARDIAN DETAILS

hereafter be made for the smooth functioning of the college.

DECLARATION BY PARENT / GUARDIAN

FREESHIP / SCHLORSHIP NOTIFICATION

October of the Current Academic Year.

Mumbai Rules and Regulaions from time to time.

(Signature of the Student) (Name & Signature of the Parent / Guardian)

FOR COLLEGE USE ONLY

Date Amount Receipt No.:

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