Application form for Admission to B.S.C.(Information Technology) Programme

N.B. 1) Fill all the columns carefully. Incomplete form will not be accepted.
2) Wrong / False information, If provided, will lead to cancellation of admission.
App. No 1544986554
Admission sought in Semester Year of B.Sc. (IT) during the academic year 2018-2019
1.Name : Mr./Ms ((IN BLOCK LETTERS)
(As appeared in HSC Certificate) Surname Name Father Mother
2.Present Address Contact No (Self)
3.Native Place Address : (For Long Journey Concession) Contact No (Parent)
4.Date of Birth 5.Place of Birth
Age 6.District
7.State 8.Nationality
9.Caste 10.Mother Tongue
11.Religion Student Email ID:
12.Adhar Card No
13.Physically Challenged  Yes/ No.  If Yes, submit documentary proof for the same Blood Group
14.Do you belong to SC/ST/DT/NT/VJ NT/ OBC/ SBC? Yes/No  (If Yes, submit documentary proof for the same for getting freeship/scholarship)
15.Do you belong to Muslim / Sikh / Boudh/ Christian/ Parsi/ Jain/ Maratha Community ? If yes put tick
 
  1. Academic Record (Attach xerox copies of Marksheet)
Examination Board / University Month & Year Of Passing Passed Class Obtained
(In case of Pass in one attampt)
S.S.C
H.S.C
F.Y.B.Sc.  (IT) Sem I
Sem II
F.Y.B.Sc.  (IT) Sem III
Sem IV
 
  1. Partiulars of Parent / Guardian)
a. Name b. Relationship will the student (in case of guardian)  
c. Occupation d. Office Address
e. Office Phone No. f. Adhar Card & of Pan Card No.
g. Total annual income from all sources h. Total no. of dependents
h.Parent Email i.Parent Mobile Number
 
DECLARATION BY THE APPLICANT

The Principal,
N.E.S. Ratnam College of Arts, Science & Commerce
Bhandup (West), Mumbai - 400078.
Madam,
I, seek admission in
class of your college with the consent of my Parent  / Guardian Mr. /Mrs.
a.I undertake to abide by all the rules and regulations of the college, particularly those relating to to conduct and discipline, which are in force at present and which may be enforced in future.
b.I undertake that i will not damage or destroy the college property / mutilate or damage any book issued to me from the college library.
c.I understand that I shall not be granted by any term, if my attendance at lectures, tutorials and practicals fall short of the minimum prescribed by the university.
d.I shall not indulge in any kind of activities which will mar the academic atmosphere and prestige of the college.
e.I know smoking is strictly prohibited in the college premises including canteen.
f.I know that use of mobile phone in the college premise is punishable as per University guidelines.
g.I understand that violation of any Discipline Rule's Will result in removal of my name from the college record and I agree to it.
Yours faithfully, (Applicant's Signature)   Date
 
DECLARATION BY THE PARENT / GUARDIAN
 
1.I, on my part agree to the condition's rules stated above.  
2.I, assure you that my ward Mr. / Ms
if admitted, will be regular in attendance at Lectures / Tutorials / Practicals/ Tests / Examinations.
3. In case the attendance / Performance of my ward is / are not satisfactory, he / she may not be granted terms and he / she may also not be sent for the College / University Exam.
4.  I am aware that violation of any of the Discipline Rule's by my ward will result in his/her removal from the college & I agree to it.  
(Signature of Parent / Guardian)   Date
 
FOR OFFICE USE ONLY
Document required to be attached
Please Tick the documents received
1.Original Marksheet of H.S.C. and 2 attested xerox copies of the same. (only for F.Y.B.Sc.I.T.)
2. Original Leaving Certificate and 2 attested xerox copies of the same. (only for F.Y.B.Sc.I.T.)
3. 1 attested xerox copy of S.S.C. Marksheet. (only for F.Y.B.Sc.I.T.)
4.Original Marksheets of lower Examinations (F.Y. / T.Y.B.Sc.I.T.) for verification (for S.Y. / T.Y.B.Sc.I.T.)
5. 1 attested xerox copy of marksheet of the lower examinations. (for S.Y. / T.Y.B.Sc.I.T.)
6. Caste certifiable and 1 attested xerox copy (only for students belonging to SC/ST/DT/NT/VJNT/OBC/SBC)
7. Affidavit (where there is a break in studies)
8. Students passing the qualifying examination from Board / University other than Maharashtra State Board / Mumbai University shall be required to attach the following additional certificates along with above mentioned certificates.
a) Original Migration Certificate and 2 attested xerox copies.
b) Original Transference Certificate and 2 attested xerox copies.
9. NOC / TC in case of students from other Colleges affiliated to University of Mumbai.