Scribd Logo
Upload

Welcome to Scribd!

  • 6 views

    Good

    Uploaded by

    vishal.d.dubey
    No

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Good

    Uploaded by

    vishal.d.dubey
    6 views2 pages
    No

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    No

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    6 views2 pages

    Good

    Uploaded by

    vishal.d.dubey
    No

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    For Office Use

    Batch: Scrutiny Payment: Online/DD PI

    Serial:
    Only

    Shree L. R. Tiwari College of Engineering (890)


    Application No :
    University of Mumbai
    M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
    520524
    Academic Year: 2024-2025 Regular
    APPLICATION FORM

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


    and Telecommunication Engineering - S.E. C-Scheme Sem III PRN:2023016402231562
    (BECBCS1001)

    Application Date : 19/10/2024 Payment Category : 25


    1.Personal Information
    Candidate's Name(Regional) :
    Candidate's Name as printed DUBEY VISHAL DEVENDRA
    on Mark sheet : [*This name will appear on all University records/documents]
    Mother's
    Father's/Husband's Name : DEVENDRA ANJU
    Name :
    Mother
    Marital Status : UnMarried
    Tongue :
    Place Of Birth : Sansarapur Gender : Male Date of Birth (DD/MM/YYYY) : 23/03/2006
    Blood Group : Religion : Country of Citizenship : India
    Is Student NRI/ Foreign National : No Domicile State: Maharashtra
    Address For Correspondence :
    Location Area : Not
    State : Maharashtra District : Palghar Tehsil : Vasai City/Town/Village :
    Available
    Address (House
    no,street/area/suburb 304,KD-2 Saidham Complex Housing Society Naigaon Pin Code : 401208
    etc.) :
    Contact details
    Mobile
    9867544048 Email ID: vishal.d.dubey@slrtce.in
    Number
    2.Legal Reservation Information
    Category Type :
    Category : GEN
    Open
    Is Guardian from EBC (Economic
    Is Specially Abled? No
    Backward Class)? No
    3.Social Information(Additional Inforamtion)
    Not Applicable
    Paper Selected for:
    Sem III
    ECC301 - Engineering Mathematics-III ECC302 - Electronic Devices & Circuits
    ECC303 - Digital System Design ECC304 - Network Theory
    ECC305 - Electronic Instrumentation & Control Systems ECL301 - Electronic Devices & Circuits Lab
    ECL302 - Digital System Design Lab ECL303 - Electronic Instrumentation & Control Systems Lab
    ECL304 - Skill Lab: C++ and Java Programming ECM301 - Mini Project 1A
    Sem IV

    ECC401 - Engineering Mathematics-IV ECC402 - Microcontrollers


    ECC403 - Linear Integrated Circuits ECC404 - Signals & Systems
    ECC405 - Principles of Communication Engineering ECL401 - Microcontrollers Lab
    ECL402 - Linear Integrated Circuits Lab ECL403 - Principles of Communication Engineering Lab
    ECL404 - Skill Lab: Python Programming ECM401 - Mini Project 1B

    Medium of Instruction : English


    4.Guardian Information
    Occupation of Guardian : Service Annual Income of Guardian : 300000
    5.Educational Details
    Month Exam
    Name of Name of Board/University Name of Certificate Mark Out
    and Year Seat CGPA %
    Examination and State of University School/College No. Obtained of
    of Passing No.
    MAHARASHTRA STATE
    BOARD OF SECONDARY
    Std 10th July 2021 -- -- 362.00 500.00 -- - -- 72.40
    AND HIGHER SECONDARY
    EDUCATION,
    MAHARASHTRA STATE
    Std 12th 12Th BOARD OF SECONDARY
    May 2023 -- -- 340.00 600.00 -- - -- 56.67
    (Science) AND HIGHER SECONDARY
    EDUCATION,
    Your Last Qualifying Exam:
    7.Other Information
    Would you like to apply for Hostel accommodation required NA
    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 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 )
    Document printed on Sat Oct 19 2024 16:02:37 GMT+0530 (India Standard Time)

    You might also like