CANDIDATE APPLICATION FORM
AY 2024-25
Subject/Core allotted: OE allotted:
Admitting Authority: Date /Signature:
1. Application Details
Stream: F.Y.B.Sc. (C.S.) Academic Year: AY 2024-25
Aadhaar No. 616919233057 University Enrollment MU2424383803
No
Student Type Inhouse Student Birth Date 11-10-2006
Mobile Number : 7400335221 Email Id : FLEVIANELSON2000@GMAI
L.COM
Category - Section A OTHER LINGUISTIC Category - Section B None
MINORITY / KANNADA
Application No : 1247 Application Date: 06/06/2024
2. Student's Information(as per Std XII Leaving Certificate)
Full Name DENZEL NELSON SELINA
Title Surname Student Name Middle Name Father's Name Mother's Name
DENZEL NELSON SELINA
Local Address: BLDG NO 186, ROOM NO 1785, SECTOR-6 KANE NAGAR, R.G ROAD, ANTOP HILL, MUMBAI 400 037
CGS QUARTERS RAOJI GANATRA ROAD, KANE NAGAR MUMBAI MAHARASHTRA INDIA 400037
Full Name - Name as DENZEL NELSON SELINA ABC Id - Academic Bank 436199901246
per HSC marksheet of Credits Id
Home town address DISTRICT-RAICHUR, Home town contact 9619752564
STATE-KARNATAKA number
Nationality INDIAN Domicile - State Maharashtra
Medical condition Blood Group B+
Caste Open Sub-Caste
Religion Christian Mother Tongue KANNADA
Gender MALE Father Qualification B.COM
Father's Designation ELECTSK Father Office Address DR HOMI BHABHA ROAD NAVY NAGAR
COLABA MUMBAI 400 005
Father Office Tel no 02222150499 Mother Qualification BA ECONOMICS
Mother Office NA Mother Office Tel no
Address
Mother's Designation HOUSEWIFE
3. Academic Details
Name of Name of Board / University Month & Seat No. Total Out Of %
Exam Year of Marks
Passing Obtained
XII HIGHER SECONDARY CERTIFICATE - MAHARASHTRA : Mar-24 M088218 348 600 58.00
Have you taken Biology NO Std XII : Marks in Mathematics XII 35
Std XII : Stream in Std XII SCIENCE
4. Document Status
Sr No Document Name Sr No Document Name
1 Std XII Leaving Certificate 2 Aadhar card
3 Student's signature 4 Student's photo
5 Std XII Marksheet 6 University enrollment form
5. Subject Electives
OE
Preference 1 Preference 2 Preference 3
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Environmental Science - Mass Media - Introduction to Media Management Studies - Foundation
Environment and Society / and Entertainment / Understanding of Human Skills / Financial
Ecotourism Cinema Literacy and Investing
UNDERTAKING BY THE STUDENT
I understand that my name appearing in the meri list followed by generation of main admission form, verification of form with
necessary attachments by the admitting authority does not guarantee admission to the set course unless and until prescribed fee for
the set course is paid by me.I request you to admit me as a student in the above mentioned class in your colege. I understand and
accept that I will not be granted terms and allowed to appear for College / University Examinations if I do not have (A) an attendance
Or atleast 75% at lectures, practicals and tutorials (B) submit projects and assignments on time, (C) attend all college examinations
and tests and that I will not be permitted to participate in (i) industrial visits (ii) teachers evaluation (iii) campus placement (iv) any
other College activity if my attendance falls below 75%. I affirm that I am not employed and ln the event of my getting employed I shall
inform immediately. I also undertake, in case of any increase in fees, to pay the difference as per schedule and as decided by the
relevant authority.
I shall abide by all the rules and regulations of the college.
Date: 01/01/1970 DENZEL NELSON SELINA
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