Form No.
Division: C
Roll No.: 333
Year / Course / Admission Category / Elective Subjects PRN No.:
UID NO: 23051875
2023-24 / FYBcom / OPEN / Student ID.
The principal,
MATUSHRI PUSHPABEN VINUBHAI VALIA COLLEGE OF COMMERCE,
M.K.School Complex, Factory Ln, Borivali West, Mumbai, Maharashtra 400092
I am applying for admission to FYBcom and paying the fees
I have not registered myself at any other institution for any course of study prescribed by the University or State Board of Education. I hearby agree to abide by the discipline rules ofthe
college.
PERSONAL INFORMATION
Name of the Student
Surname : PANCHAL First Name : HARSH MiddleName/Father Name : MANOJ
Name of the Student: (in Local Language)
Surname : PANCHAL First Name : HARSH Middle/Father Name : MANOJ
Name of the Student as printed on std. 10 Passing Certificate
Surname : PANCHAL First Name : HARSH Middle/Father Name : MANOJ
Father's / Husband's Name
Surname : PANCHAL First Name : MANOJ Middle/Father Name : TUKARAM
Mother's / Husband's Name
Surname : PANCHAL First Name : SHASHIKALA Middle/Father Name : MANOJ
Have you changed your name?: NO
Gender: MALE Date of Birth: 2004-04-28 Age: 19
Marital Status: UNMARRIED Student's location Category: URBAN Voter ID No:
Place of Birth: MUMBAI Mother Tongue: MARATHI Religion: HINDU Blood Group:
Aadhaar Number: 483342646470 Admission in which category: OPEN Caste: OPEN Sub Caste:
Nationality: INDIAN Domicile State: MAHARASHTRA Student Mob No: 8408829622 Email: [email protected]
Address to Correspondence: B101, AABHAS COMPLEX, TULINJ ROAD, MAHESH PARK, NALASOPARA EAST
Citizen of (Country Name): INDIA State: MAHARASHTRA City: MUMBAI Pincode: 401209
Residensial Phone No: 0 Father Mob No: 9673851430 Mother Mob No: 0
Native Place Address: B101, AABHAS COMPLEX, TULINJ ROAD, MAHESH PARK, NALASOPARA EAST
Citizen of (Country Name): INDIA State: MAHARASHTRA City: MUMBAI Pincode: 401209
Residensial Phone No: 0 Student Mob No: 8408829622 Physically disabled ?: NO
Nearest railway station(Long journey railway concessions will be issued only to the started
here):
EDUCATION DETAILS
Optional Subject
Name of Month and Year Seat No / Total Obt. Marks Out Qualifying
Name Of Board/University Name Of School through which passed % of Marks
Examination : of passing Roll No. Marks Of Examination?
10TH MAHARASHTRA BOARD ST. FRANCIS JUNE-2020 A176141 349 500 69.80 % YES
12TH MAHARASHTRA BOARD SVDV JUNE-2022 M295812 320 600 53.33 % YES
PARTICULARS OF PARENTS
Parents Name (Father): MANOJ Occupation of the Parent (Father): Occupational Address (Father): Office Telephone No (Father):
Parent Aadhaar Number (Father):
Family Annual Income: 100000 Relationship with the applicant (Father): Mobile No (Father): 9673851430
111111111111
OTHER INFORMATION SECTION
Hobbies/ Proficiency / Other Interface: Game and Sport Participation:
Level Of Participation: Personal Identification Marks:
DOCUMENT
10TH CERTIFICATE 12TH CERTIFICATE LEAVING CERTIFICATE
DECLARATION
I hereby declare that, I have read the rules related to admission and the information filled 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 undertake that, in absence of any document the final admission will not be granted and / or admission will stand cancel.
1. I will abide to all the condition. I am aware of the Maharashtra Prohibition of Ragging Act. 1999 and I state that will be abide by all the rules and regulation of the said Act.
2. I have permitted my son / Daughter / ward to join the college and shall see that he/she observe the rules and regulation of the college and H.S.C Board.
3. I am aware of the fact that minimum 75% attandance is required separately during both terms of the academic year and my son / daughter shall abide by it uncomplainingly.
4. I hearby agree and give my consent that my son / daughter's application for admission to the H.S.C Board Examination be withdrawn in case he / she fails to fullfill the 75% Criteria /
Rule.
Place: MUMBAI
Date: 27-06-2023 Name and Signature Of Student: Name and Signature Of Parent / Guardian:
Student Copy
MATUSHRI PUSHPABEN VINUBHAI VALIA COLLEGE OF
COMMERCE
Year / Course / Admission Category
UID NO: 23051875
2023-24 / FYBcom / OPEN
