Session 2020-2021
HISLOP COLLEGE College Code
:HCN
Temple Road,Civil Lines,Nagpur 440001
For College Course Applied to: B.SC - II (SEM 3) Registration No.
use only 878663
Admission Date :
01. Personal Information Section
LAST NAME FIRST NAME MIDDLE NAME
Name of the Student RATHOD KRUSHNA VASANT
Father's Name VASANT NAMDEV RATHOD
Mother's Name : SAVITA
Marital Status : Saral No. :
Date of Birth : 31/12/2001 Gender : Male
Place of Birth : SINGODA Blood Group : AB+
Grandfather Name : Native Place : Singoda
Voter ID Card No. : Organ Donar : NO Medium : ENGLISH
Bank Name : Account No. : Transaction Type : ONLINE
Religion : HINDU Citizenship of : Indian U-DISE No. :
Aadhar Card No. : 214730799520 Driving Licence No. : Minority: YES
02. Address Details
Address for Correspondence: At post shingoda tq kinwat dist nanded
Pin Code : 431804
Singoda
State : maharastra District : NANDED Tehsil : KINWAT City : SINGODA
At post shingoda tq kinwat dist nanded
Permanent Address Pin Code : 431804
Singoda
State : maharastra District : NANDED Tehsil : KINWAT City : SINGODA
03. Contact Details
Student Phone : Parent Phone : 9689838934
Student Mobile No.: 7720066396 Student Email Id: [email protected]
04. Legal Reservation Information Section
Domicile State : MAHARASHTRA Type of Category : Reserve Category Caste Category : VJNT
Sub Caste : BANJARA Phy. Handicapped :
Caste Certificate No. : Learning Disability No. :
05. Social Reservation (Special Category) Information Section
SR NO. SOCIAL RESERVATION NAME
06. Education Details Section
Name of Name of School Date of Examination Passing Grade / Obt CGPA
Name of
Board / College Passing Seat No. Certificate No. Total Marks %
Examination
Marks
07. Qualifying Exam Details Section
Qualifying Exam Name : HSC (SCI)
College/School Board/ Admission Passing Marks Total Percentage Place Arts/Com Education
Attended University Year Year Obt Marks /Sci Gap
Shri kshetra ajubai 0 0 531 650 81.69 NO
presidency senior and
junior college anwa tq
Qualifying Exam Subject Details
Sr.No. Subject Name Total Marks Obtained Marks
1 MATHEMATICS 100.00 92.00
2 CHEMISTRY 100.00 87.00
08. Subject Details Section
Preferenace : 1 Group Name : PEM
PHYSICS
MATHEMATICS
ELECTRONICS
ENVIROMENTAL STUDIES
09. Attached Documents
Sr No. Name of Documents/Certificates
1 UNDERTAKING FORM COLLEGE WEBSITE(ONLY FOR SEM 3 AND 5)
2 STUDENT AADHAR CARD
3 FATHER OR MOTHER AADHAR CARD
10. Guardian / Parent Information Section
Guardian's/ Parent's Name :
Occupation of the Guardian/Parent : Annual Income of the guardian/Parent :
Relationship of Guardian with applicant : Son Guardian/Parent Phone No. : 9689838934
11. Other Information Section
Mother Tongue : Banjara Employment Status : NO Do you wish to join NCC / NSS: YES
Would you like to apply for Hostel : NO
Hobbies, Proficiency and Other interests : NA
Games and sports participation :
Personal Identification Marks : Mole on left hand
12. Declaration by Student
I hereby declare that, I have read the rules related to admission and the information filled in 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 I undertake that, in absence of any document the final admission will not be granted and / or admission will
stand cancel.
Place :
Date :
Signature of the Student:
13. Declaration by Guardian / Parent
I have permitted my son / daughter / ward to join your college.The information supplied by him / her is
correct to the best of my knowledge. I have acquainted myself with the rules and fees, dues to my son / daughter / ward and see
that he / she observes.
Place :
Date :
Signature of the Guardian/Parent:
14. For College / Institute Use Only
Designation Remarks / Particulars /Recommendations Signature and Date
Admission Clerk
Admission Committee
Accountant / Cashier
Registrar/Office Cash Received : Rs 50.00
Superintendent
REMARK OF THE ADMISSION COMMITTEE
May be admitted to Class_____________________________________________________ Section__________________
May be Rejected____________________________________________________________________________________
Last date of payment of fees __________________________________________________________________________
Admission may be cancelled if the fees are not paid by this date.
Principal Signature of Admission Committee
