6/18/2019 Receipt-cum-Acknowledgement for Direct Second Year of Three/Four Year Diploma Courses in Engineering / Technology 2019 - 2020

GOVERNMENT OF MAHARASHTRA
Directorate Of Technical Education ,Maharashtra State
3, Mahapalika Marg, Post Box 1967,Mumbai- 400001.(M.S.).
Receipt-cum-Acknowledgement for Admission to Direct Second Year of Three/Four Year Diploma Courses in
Engineering / Technology for the year 2019-2020

Mode of Application : G1 - HSC Science Application ID : DSD19118884 Version : 1

Payment Details
Payment Date : 17-06-2019 Amount(In Rs.) : 300 /-

Personal Details :
Full Name : CHAVAN RAVI BABAN

Gender : Male Date of Birth : 15-03-1999

Caste-Category (Sr.No.) : DT/VJ NT(A) - Banjara [7] Religion : Hindu

Category For Admission DT/VJ NT(A) - Banjara [7]

Mother Tongue : Marathi Family Income ( ) : 15,001 - 50,000

Nationality : Indian

Type of Candidature : Maharashtra State Candidate - Type A

Religious Minority : N.A. Linguistic Minority : N.A.
PH Type : N.A.
Defence Type : N.A.
7529XXXX5253
I, the holder of Aadhaar Number [7529XXXX5253 ], hereby give my consent to State CET Cell to obtain my Aadhaar number for
Aadhaar Number :
authentication with UIDAI. State CET Cell has informed me that my identity information would only be used for admission purpose
and will be submitted to CIDR only for the purpose of authentication.

District from which candidate has passed S.S.C.(Std. X)/Equivalent Examination Parbhani
District from which candidate has Passed HSC Science Parbhani
HSC Science Course : H.S.C. (PCB)

Qualification Details:
Examination Marks Obtained Marks Out Of Percentage
HSC Science Aggregate : 453 650 69.69
10th/S.S.C. Aggregate : 300 500 60.00
10th/S.S.C. Mathematics : 58 100 58.00
10th/S.S.C. Science : 40 100 40.00
10th/S.S.C. English : 38 100 38.00

Sr. No. List of Submitted Documents at the time of verification at FC

1 Statement of marks obtained at 10th/SSC or its Equivalent Examination
2 The School Leaving Certificate indicating the Nationality of the Candidate as 'Indian' Or The Place Of Birth In India.
Caste Certificate clearly mentioning the Category of the Candidate and also the remarks that the caste is recognized as backward
3
class in the State of Maharashtra.
4 Non-Creamy Layer Certificate valid upto 31st March 2020
5 Statement of marks obtained at HSC Science Examination

FC Remark : all documents are uploaded

Declaration:
I have read all the rules of admission and on understanding these Rules, I have filled this Application Form for consideration of submission of
Application Form at FC for the admission to Direct Second Year of Three/Four Year Diploma Courses in Engineering / Technology for the
academic Year 2019 - 2020. The information given by me in this application is true to the best of my knowledge & belief. If at later stage, it is
found that I have furnished wrong information and/or submitted false certificate(s), I am aware that my admission stands cancelled and fees
paid by me will be forfeited. Further I will be subject to legal and/or penal action as per the provisions of the law.

Date : 18-06-2019 Printed On: 18-06-2019 03:14:55 PM

Signature of the Candidate
Place :
(CHAVAN RAVI BABAN)

Confirmed On: 18-06-2019 03:14:53 PM Confirmed By: FC2197 Printed By: FC2197

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6/18/2019 Receipt-cum-Acknowledgement for Direct Second Year of Three/Four Year Diploma Courses in Engineering / Technology 2019 - 2020

FC USE ONLY
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