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Sant Gadge Baba Amravati University: Backlog From Session Winter-2019

1. This document is a backlog application form for Vinay Kiran Gulhane to appear for the Semester VI examination of the B.E. in Civil Engineering (CGS) program at G.H. Raisoni College of Engineering and Management. 2. It provides personal details of Vinay such as name, date of birth, gender, category, religion, subject for the examination which is Transportation Engineering-II. 3. The applicant is required to affirm that he has participated in required activities as per university ordinances and rules and that the information provided is true and correct.

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Prashant pande
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623 views2 pages

Sant Gadge Baba Amravati University: Backlog From Session Winter-2019

1. This document is a backlog application form for Vinay Kiran Gulhane to appear for the Semester VI examination of the B.E. in Civil Engineering (CGS) program at G.H. Raisoni College of Engineering and Management. 2. It provides personal details of Vinay such as name, date of birth, gender, category, religion, subject for the examination which is Transportation Engineering-II. 3. The applicant is required to affirm that he has participated in required activities as per university ordinances and rules and that the information provided is true and correct.

Uploaded by

Prashant pande
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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SANT GADGE BABA AMRAVATI UNIVERSITY

BACKLOG FROM
SESSION   WINTER-2019
Type of Programme UG
Name of Course B.E in CIVIL ENGINEERING (CGS) - Semester - VI
Branch (B.E in CIVIL ENGINEERING (CGS))
G.H. Raisoni College of Engineering and Management,Anjangaon Bari
Name of College
Road-(810)
College Code 810
College Area Urban
PRN/Enrollment No 178109148036

PERSONAL DETAILS
1. Full Name Of The Applicant: VINAY  KIRAN GULHANE
2. Father's/Gaurdian's/Husband's Full Name: Mr. KIRAN MAHADEVRAO GULHANE
3. Mother's Full Name: Mrs. JYOTI
3. Address For Communication: 28 BHARTIYA COLONY DASTUR NAGAR AMRAVATI,-,-
(With Pin Code) ,444606
4. Permanent Address: 28 BHARTIYA COLONY DASTUR NAGAR AMRAVATI,-,-
(With Pin Code) ,444606
5. E-mail-ID  : [email protected] 6. Contact No.  : 9604982486
7. Date of Birth: 3/11/1997 8. Gender: MALE
9.Category: OBC 10.Religion: HINDU
11.Mother Tongue: MARATHI 12.Medium of Instruction: English
13.Differently Abled/Divyang: NO 14.Nationality: Indian
Subjects offered:  
SUBJECT CODE SUBJECT NAME
11904 Transportation Engineering-II
 
Note : 1. Student are directed to refer (drop box) for subject abbreviation /code.
2. Student are directed to kindly read instruction carefully (drop box).

SESSION   WINTER-2019
EX-STUDENT (BACKLOG)
Name of Examination :  (B.E in CIVIL ENGINEERING (CGS)) Medium :  English
Semester :  Semester - VI.
Subject (Only for P.G.Exams) : 
Examination Centre : 
 
a. As per provision of the ordinance No.1 of 1985 ,I have participated in the activities.
b. As is not permitted in the Ordinance, I am not appearing in any other Examination.
c. I solemnly affirm that the complete information given in this application form is true and correct. If any information given
in this form found to be false I shall be eligible for imposition of fine and punishment & shall be personally responsible for
any loss.
d. I understand that my application form shall be rejected or result of examination shall not be declared in case of appearing
any discrepancy/deficiency in this application form as well as for non-compliance of the same within the stipulated time.

Date : Applicant Signature


 
 
(Student should take a print & submit to college in duplicate along with document )
 
CERTIFICATE OF PRINCIPAL
(For collegiate students only )
 
a. Certified that applicant student has been Enrolled in Sant Gadge Baba Amravati University and he /she has fully complied
all conditions and provisions prescribed in the concern Ordinance and regulations and rules. There is no objection
regarding his/her character which could be a disqualification for appearing in the examination.
b. Original certificates/Marksheets/Degree/Diploma as an eligibility qualification issued by the Board/University to this
student are verified and he/she is eligible for admitting in this examination.
c. This student has participated in the activities viz....................,as per provisions of Ordicance No./1985.
 
 
 
Date: Principal -------------- (Sig. & Stamp)

FEE DETAIL (FOR OFFICIAL USE ONLY)


The Fee Amount to be Paid by Candidate is : RS   670 /-

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