Shri T P Bhatia Jr. College of Science

For Office Use


Today(MM/DD/YYYY)
Form No.
GR. No. (TEMPERORY)
Section
Fees Structure
Fees Amount

Personal Details


Surname
First Name
Father's Name
Mother's Name
Gender
Nationality
Religion
Caste
Mother Tongue
Medium Of Instruction
Handicapped
Date Of Birth (MM/DD/YYYY)
Place of Birth
Blood Group
Residential Address
Line 1
Line 2
Line 3
Area
City
State
Pincode
Contact Number
Parent's Number
Home Number
Email ID
Category Of Candidate
WHETHER FOREIGNER

Parental Details


Parent's Full Name
Relationship With Ward
NO. OF Children
Occupation
Annual Income
Mobile Number
Office Address
Line 1
Line 2
Line 3
Area
City
State
Pincode
Office Contact
Bank Name
Account Type
Account Number

XIth Details


Subject Taken
Division
Roll No
Out Of
Marks Scored
Percentage
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.

Signature of Student

____________________

Signature of Guardian

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