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SHRI T P BHATIA COLLEGE OF SCIENCE

APPLICATION FOR ADMISSION TO SHRI T P BHATIA COLLEGE OF


SCIENCE, H.S.C. EXAMINATION OF MAR-2016
1. DEAR STUDENT, THESE ARE THE DETAILS YOU HAVE FILLED IN YOUR ADMISSION FROM.
2. IF YOU FEEL THAT ANY DETAILS ARE INCORRECTLY FILLED BY YOU, THEN CONTACT YOUR CLASS
TEACHER OR COLLEGE OFFICE AS SOON AS POSSIBLE.
3. REMEMBER THAT YOUR DATA WILL BE SUBMITTED TO MAHARASHTRA STATE BOARD FOR YOUR COMING
H.S.C. EXAM.
FORM NO

TPBSY-2015-14482

GRNO

18369

SURNAME

KAWA

FIRST NAME

SACHIN

FATHER'S NAME

LALIT

MOTHER'S NAME

USHA

RESIDENTIAL ADDRESS

445-22, BANDHUTWA CHS, SEC-4,


CHARKOP. KANDIVALI (W)
MUMBAI-400067
Pincode : 400067

DATE OF BIRTH (YYYY-MM-DD)

1998-07-14

PLACE OF BIRTH

MUMBAI

BLOOD GROUP

O+

GENDER

MALE

IF BELONG TO MINORITY RELIGION

NON-MINORITY

CASTE CATEGORY

OPEN

HANDICAPPED OR NOT-HANDICAPPED

NO-HANDICAPPED

FOREIGNER

NO

YOU BELONG TO BI-FOCAL , IT OR GENERAL


SCIENCE

BI-FOCAL

YOUR SUBJECT COMBINATION YOU ARE STUDYING FOR HSC EXAMINATION


(COMPULSORY SUBJECTS : ENGLISH , PHYSICS , CHEMISTRY , EVS AND PT)
LANGUAGE 1

ENGLISH

LANGUAGE 2

SUBJECT 1

MATHEMATICS

SUBJECT 2

PHYSICS

SUBJECT 3

CHEMISTRY

SUBJECT 4

COMPUTER SCIENCE

SUBJECT 5

COMPULSORY SUBJECT 1

ENVIRONMENTAL EDUCATION

COMPULSORY SUBJECT 2

PHYSICAL EDUCATION

PREVIOUS EXAMINATION PASSING DETAILS


S.S.C.

XI-th

SEAT NO

A308900

SEAT NO / ROLL
NO

26

MONTH

Feb

MONTH

Feb

YEAR

2014

YEAR

2015

NAME OF
BOARD

MAHARASHTRA STATE BOARD

NAME OF JR.
COLLEGE

SHRI T P BHATIA COLLEGE

WHETHER S.S.C. EXAMINATION PASSED FROM MAHARASHTRA STATE


BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION, PUNE

CONTACT DETAILS

Maharashtra State Board

STUDENT'S
NUMBER

7715922488

PARENT'S
NUMBER

9869759858

HOME NUMBER

9768101717

EMAIL ID

SACHIN.KAWA.98SK@GMAIL.COM

PARENT'S DETAILS
PARENT'S FULL
NAME

LALIT AMARSI KAWA

RELATIONSHIP
WITH STUDENT

FATHER

NO. OF
CHILDREN

OCCUPATION

ENGINEER

ANNUAL
INCOME

400000
Pincode : 0
Office Contact : -

OFFICE ADDRESS

XI-TH DETAILS
DIVISION

XI-TH MARKS DETAILS (PRINTED ON XI-TH


MARKSHEET)

ROLL NO

26

OUT OF

650

MARKS SCORED

396

PERCENTAGE

60.92

CLASS

FIRST CLASS

DECLARATION

All Information Entered here are correct to my knowledge. I agree that my admission may get rejected
in case of any untrue information provided by me. I do here by promise to obey rules and regulation of
the institution once i am selected for admission. I seek admission to FYJC/SYJC Science Class of your
Jr. College. I shall abide be the rules and regulations of the college relating to the attendance and
discipline and those of the Maharashtra State Higher Secondary Board. I also declare that, I have not
registered my self at any other college or institution for any other course. I am aware that i will not be
eligible for First Year / Second year Jr. College Examination at the end of the year, if my attendance is
less than 75% at the lectures / tutorials / practical engaged in each term separately. I give below all the
pariculars required. We have noted and agreed to the above statements. As a parent, I shall ensure
that my ward abides by the rules and regulations of the college relating to the attendance and
discipline.

PARENT'S / GUARDIAN SIGNATURE

________________________________

STUDENT'S SIGNATURE

________________________________

FORM FEES ( IN CASH )

Rs. 50

ADMISSION FEES

Rs. 32,000 IN D.D.

DEMAND DRAFT ( D.D. ) IN FAVOUR OF

Shri. Tikamdas Purshotam Bhatia Junior College of Science


* * * ALL THE BEST * * *

2015 SHRI T P BHATIA COLLEGE OF SCIENCE.


ALL RIGHTS RESERVED.
DESIGNED AND DEVELOPED BY MR. ASHISH PANDEY.

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