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Vishwaniketans Institute of Management Entrepreneurship and Engineering Technology (990)

Survey no 52 Near Khalapur Toll Naka Khalapur Application No :
University of Mumbai 2796198
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
Academic Year: 2023-2024 Regular
APPLICATION FORM

Course Applied for : B.E.(with Credits) - Regular - CBCS - Computer

Science and Engineering (Artificial Intelligence and Machine Learning) - ABC ID: 892-254-315-381 PRN:
F.E. C-Scheme Sem I [1T01831] (BECBCS1001)

Application Date : 31/08/2023 Payment Category :

1.Personal Information
Candidate's Name(Regional) : गणेशकर धिरज उमाकांत
Candidate's Name as printed GANESHKAR DHIRAJ UMAKANT
on Mark sheet : [*This name will appear on all University records/documents]
Mother's
Father's/Husband's Name : UMAKANT SAVITA
Name :
Mother
Marital Status : UnMarried Marathi
Tongue :
Place Of Birth : Gunj Bk Gender : Male Date of Birth (DD/MM/YYYY) : 27/06/2005
Blood Group : Religion : Hindu Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
City/Town/Village :
State : Maharashtra District : Jalna Tehsil : Jalna Location Area : Urban
JALNA
Address (House
ROW HOUSE NUMBER 2 PLOT NUBER 7B SR N 45 TIRUPATI INCLVE-2
no,street/area/suburb Pin Code : 431203
RUPNAGAR MAHASUL Colon JALNA
etc.) :
Permanent Address :
City/Town/Village :
State : Maharashtra District : Jalna Tehsil : Jalna Location Area : Urban
JALNA
ROW HOUSE NUMBER 2 PLOT NUBER 7B SR N 45 TIRUPATI INCLVE-2
Address : Pin Code : 431203
RUPNAGAR MAHASUL Colon JALNA
Contact details
Mobile
9322931057 Email ID: dhirajganeshkar4@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : GEN Is EWS? : Yes
Open
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? Yes
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
 Sem I [1T01831]
58651 - Engineering Mathematics-I 58652 - Engineering Physics-I
58653 - Engineering Mechanics 58654 - Basic Electrical Engineering
58655 - Engineering Chemistry-I FEC101 - Engineering Mathematics-I Term Work
FEL101 - Engineering Physics-I (TW) FEL102 - Engineering Chemistry-I (TW)
FEL103 - Engineering Mechanics (TW/OR/PR) FEL104 - Basic Electrical Engineering (TW/OR/PR)
FEL105 - Basic Workshop Practice-I
Sem II [1T01832]

29711 - Engineering Mathematics-II 29712 - Engineering Physics-II

29713 - Engineering Chemistry-II 29714 - Engineering Graphics
29715 - C programming 29716 - Professional Communication and Ethics- I
FEC201 TW - Engineering Mathematics-II Term Work FEL201 - Engineering Physics-II (TW)
FEL202 - Engineering Chemistry-II (TW) FEL203 - Engineering Graphics (TW/Orl)
FEL204 - C programming (TW/Orl) FEL205 - Professional Communication and Ethics- I (TW)
FEL206 - Basic Workshop practice-II (TW)

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Service Annual Income of Guardian : 45000
5.Educational Details
Month
Name of Name of Board/University Name of and Year Exam Certificate Mark Out
CGPA %
Examination and State of University School/College of Seat No. No. Obtained of
Passing
MAHARASHTRA STATE
C.T.M.K
BOARD OF SECONDARY AND
Std 10th GUJRATHI July 2021 K107077 -- 400.00 500.00 -- - -- 80.00
HIGHER SECONDARY
JALNA
EDUCATION,Maharashtra
MAHARASHTRA STATE
Std 12th BOARD OF SECONDARY AND JIJAU HIGH February
R063305 -- 383.00 600.00 -- - -- 63.83
Science HIGHER SECONDARY SCHOOL JALNA 2023
EDUCATION,Maharashtra
Your Last Qualifying Exam: HSC/Std 12th [Science]
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Passing Certificate of Std 12th / Statement of Marks of Std 12th OR Original Passing Certificate /Statement of Marks of Last
Qualifying Exam like degree,diploma,etc.

Passing Certificate of Std 10th.

Leaving Certificate.

Statement of Marks of Std 10th.

Original Statement of Marks for std. 12th.

Passing Certificate of Std. 10th.

Passing Certificate of Std. 12th/Statement of Marks of std.12th.

School/College Leaving Certificate.

Statement of Marks of Std. 10th.

DECLARATION
I hereby declare that all the information furnished by me in this application form is true, complete and correct to the best of my
knowledge and belief. I do understand that I need to obtain and produce all the required documents. I Application No :2796198
(GANESHKAR DHIRAJ UMAKANT) admit to having understood what constitutes ragging and sexual harassment. I have read the
guidelines related to the same. I hereby affirm that if found guilty of ragging or sexual harassment I am liable for punishment
according to the university regulations.

Place : Date :
( Signature of the Candidate )
For College/Institute/Study Center Use Only
Designation Signature and
Remarks / Particulars / Recommendations
Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: INR Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Wed Sep 27 2023 22:45:01 GMT+0530 (India Standard Time)