Savitribai Phule Pune University

MAHATMA GANDHI VIDYAMANDIR

MAHARAJA SAYAJIRAO GAIKWAD COLLEGE

Loknete Vyankatrao Hirey Marg,Malegaon Camp Malegaon

02554252077, Email ID : msgcollege@rediffmail.com
Admission Form Details (Academic Year : 2019-2020)

Form Verification (For Office Use Only) Fill Date : 26/08/2019 01:32 PM - Print Date : 26/08/2019 01:32 PM

Sign. Sign.
Div & Subject Alot. Auth Division Roll No. Rcpt. Made By Rcpt. No. Amount Date

Sign. Sign.
Form Checked By Scholarship Verification Fee Category Caste Category Caste Member ID

Registration Information

Admission Form Number : 814489

Registration Number : 1900208963

Admission Type : Section : Class :

Provisional SENIOR F.Y.B.SC .(CREDIT)
Division : Fee Category : Caste Category :
GRANT OBC SCHOLARSH OBC
Form No. (Merit/Adm.) : Uni./Board Registration No. : Eligibility No.(UG & PG) :
N.A. N.A. N.A.
Adhaar Card No. : Pan Card No. : Voter ID :
581079242515 N.A. N.A.
Saral ID. :
N.A.

Student's Information

Student's Name :
BORSE HITENDRA NARAYAN
Father's Name : Mother's Name :
BORSE NARAYAN SHANKAR TANUJA
Local Address :
Krushi Nagar,Malegaon Camp
Tal-Malegaon,Dist-Nashik
Location : Taluka : District :
Malegaon Malegaon Nashik
State : Country : Pin Code :
Maharashtra INDIA 423203
Permanent Address :
Krushi Nagar,Malegaon Camp
Tal-Malegaon,Dist-Nashik
Location Type: Email ID :
Urban hitendraborse588@gmail.com
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Mobile No. : Father's Mobile No. : Phone No 1 :
8329710925 9665811856 N.A.
Gender : Birth Date : Mother Tongue :
Male 24/12/2001 Marathi
Occupational Status: Blood Group : Handicap :
Unemployed O+ No
Religion : Caste : Caste Validity No.:
HINDU KUNBI N.A.
Ration Card Type :
Orange

Last Year's Details with (TC/LC)/Migration/Eligibility Information

Last Attended Institute Name :

M.S.G.JR.COLLEGE,MALEGAON
Last Attended Examining Body (Board/University) :
MAHARASTRA STATE BOARD
Last Attended Class : Last Attended College/School UDISE Code :
12 TH SCIENCE N.A.
Eligibility : State of Residence : Last Qualified Exam :
Same Institute/College M.S. 12 TH SCIENCE
Passing Month : Passing Year : Percentage :
Mar 2019 51.85
Result : Attempt : Exam Center :
II Class 1st 0240
Seat No. : T.C./L.C. No. : T.C./L.C. Date :
S016235 N.A. N.A.
Migration Cert. No. :
N.A.

Subject's Information

Medium : N.A.
Subject Name Subject Code Subject Group
1) Physics I PHY-111 Optional Sub-Group - AAE1
2) Physics II PHY-112 Optional Sub-Group - AAE1
3) Physics Practical III PHY-113 Optional Sub-Group - AAE1
4) Physics I PHY-121. Optional Sub-Group - AAE1
5) Physics II PHY-122 Optional Sub-Group - AAE1
6) Physics Practical III PHY-123 Optional Sub-Group - AAE1
7) Chemistry Practical III CH-203 Sub-Group - AAA1
8) Chemistry I CH-101 Sub-Group - AAA1
9) Chemistry II CH-102 Sub-Group - AAA1
10) Chemistry Practical III CH-103 Sub-Group - AAA1
11) Chemistry I CH-201 Sub-Group - AAA1
12) Chemistry II CH-202 Sub-Group - AAA1
13) Mathematics I MT-111 Sub-Group - AAC1
14) Mathematics II MT-112 Sub-Group - AAC1
15) Mathematics Practical III MT-113 Sub-Group - AAC1
16) Mathematics I MT-121 Sub-Group - AAC1
17) Mathematics II MT-122 Sub-Group - AAC1

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18) Mathematics Practical III MT-123 Sub-Group - AAC1
19) Statistics I ST-101 Sub-Group - AAD1
20) Statistics II ST-102 Sub-Group - AAD1
21) Statistics Practical III ST-103 Sub-Group - AAD1
22) Statistics I ST-201 Sub-Group - AAD1
23) Statistics II ST-202 Sub-Group - AAD1
24) Statistics Practical III ST-203 Sub-Group - AAD1
25) Physical Education C19999 Subject Group - A

List of Documents Attached

1) AADHAAR Card 2) Anti-Ragging Form

3) Caste Certificate 4) Income Certificate
5) Marksheet (First Year)

BORSE HITENDRA NARAYAN BORSE HITENDRA NARAYAN

Scanned Signature Student's Signature

Undertaking

We hereby certify that the information provided in this application form is correct. We undertake to
abide by the rules and regulations of the college and the orders issued by the competent authorities from time
to time. We are agree that decision of the principal in respect of the student’s admission will be binding upon
us.

Parent's Signature Student's Signature

Admission Admission Not

Principal's/Vice Principal's/Authority Signature Confirmed Confirmed

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 ANTI RAGGING AFFIDAVIT BY THE STUDENT
Class : F.Y.B.SC .(CREDIT) -- Academic Year : 2019

Registration No. :1900208963 Date : 26/08/2019 01:32 PM

1. I, BORSE HITENDRA NARAYAN S/O or D/O Mr./Mrs./Ms. BORSE NARAYAN SHANKAR having
been admitted to MAHATMA GANDHI VIDYAMANDIR MAHARAJA SAYAJIRAO GAIKWAD
COLLEGE have received a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher
Educational Institutions, 2009, (hereinafter called the Regulations) carefully read and fully understood the
provisions contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penal and administrative action that is liable to be taken against me in case I am found guilty for abetting
ragging, actively or passively, or being part of a conspiracy to promote ragging.
4. I hereby solemnly aver and undertake that I will not indulge in any behaviour or act that may beconstituted
as ragging under clause 3 of the Regulations.I will not participate in or abet or propagatethrough any act of
commission or omission that may be constituted as ragging under clause 3 of the Regulations.
5. I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of the
Regulations, without prejudice to any other criminal action that may be taken against me under any penallaw or
any law for the time being in force.I hereby declare that I have not been expelled or debarred fromadmission in
any institution in the country on account of being found guilty of, abetting or being part of a conspiracy to
promote, ragging; and further affirm that, in case the declaration is found to be untrue, I am aware that my
admission is liable to be canceled.

Declared on ______________________

__________________________________
Signature of Student
Name : BORSE HITENDRA NARAYAN
Adress : Krushi Nagar,Malegaon Camp, Malegaon, Malegaon, Nashik, , Maharashtra, INDIA, 423203

Verification
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is
false and nothing has been concealed or misstated therein.

Verified at _________________________________ on _________________________________

Signature of Student

(NOTE: There is no need to get your affidavits printed on any stamp paper or get it signed by an Notary
or an oath Commissioner.)

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 AFFIDAVIT BY PARENT/GUARDIAN
Class : F.Y.B.SC .(CREDIT) -- Academic Year : 2019

Registration No. :1900208963 Date : 26/08/2019 01:32 PM

1. I Mr./Mrs./Ms., BORSE NARAYAN SHANKAR father/mother/guardian of BORSE HITENDRA

NARAYAN having been admitted to MAHATMA GANDHI VIDYAMANDIR MAHARAJA SAYAJIRAO
GAIKWAD COLLEGE have received a copy of the UGC Regulations on Curbing the Menace of Ragging in
Higher Educational Institutions, 2009, (hereinafter called the Regulations) carefully read and fully understood
the provisions contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penaland administrative action that is liable to be taken against my ward in case he/she is found guilty of or
abetting ragging, actively or pasively, or being part of a conspiracy to promote ragging.
4. I hereby solemnly aver and undertake that My ward will not indulge in any behaviour or act that may be
constituted as ragging under clause 3 of the Regulations. My ward will not participate in or abet or propagate
through any act of commission or omission that may be constituted as ragging under clause 3 of the
Regulations.
5. I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to clause 9.1 of
the Regulations, without prejudice to any other criminal action that may be taken against my ward under any
penal law or any law for the time being in force.
6. I hereby declare that my ward has not been expelled or debarred from admission in any institution in the
country on account of being found guilty of, abetting or being part of a conspiracy to promote, ragging; and
further affirm that, in case the declaration is found to be untrue, the admission of my ward is liable to be
cancelled.
Declared on ______________________

__________________________________
Signature of Parent/Guardian
Name : BORSE NARAYAN SHANKAR
Adress : Krushi Nagar,Malegaon Camp, Malegaon, Malegaon, Nashik, , Maharashtra, INDIA, 423203

Verification
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is
false and nothing has been concealed or misstated therein.

Verified at _________________________________ on _________________________________

Signature of Parent/Guardian

(NOTE: There is no need to get your affidavits printed on any stamp paper or get it signed by an Notary
or an oath Commissioner.)

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support@vriddhisoftware.com.(Form No.:814489)