Application Form

Printed on

8/29/2013 12:29:57 PM

Course

Master of Management Studies

Application Number
Appilcation type

GOI Post Matric Scholarship , 2013-2014

Other Backward Class

APPOPE0947364M200520
13

Please Paste
Passport Size
Photograph

Renewal Course Year N.A

Renewal

Student SSC Details

SSC Board

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION

Passing Year

2005

SSC Seat No

OPE094736

SSC Marks Obtained

62.80

Applicant Name Mayur

Dattatray

Gharat

Date of Birth

Gender

Male

Is Resident of Maharashtra Maharashtra

Maritial Status

No

Caste Category

Applicant's Details

21-11-1989

Application Date 24-08-2013

Caste

Mother's Name

Agari (169)

Orphan

Sunanda

Other Backward Class

Sub Caste

No

Is Disabled

No

Disability Type

Is Applicant Salaried ? NO

Applicant's
Annual Income

0.00

Total Annual Income 60000.00

Is Staying at Hostel ?

Has Applied For Hostel ?

No

N.A.

No

Student Prequalifying Details

Academic Year

Institute

Course

Course Year

Percentage

Result

2012 - 13

Maratha mandirs babasaheb

Master in Management Studies 1
gawdeinstitute of management Full Time
studies

70.00

Pass

2011 - 12

No Institute attended

Course not Attended

0.00

Fail

2010 - 11

MIT PUNE

Bachelor of Engineering

61.00

Pass

Institution Details
Name of School/College/Institute
where Admitted

Maratha Mandir's Babasaheb Gawde Institute of Management Studies, Mumbai 400008

Course Name

Master of Management Studies

Course Year

EID Number

2017/90081/04932 02/04/2013 18:55:32

Subject

Marketing

CAP Number

MB12100504

Academic Year

2013-2014

College Adm.No 1093

Admission Dt.

16-07-2012

Is Fees Paid ?

No

Fee Paid

0.00

N.A

GrantType

Non Granted

Fee Receipt
Date
Contact Details

UID Number

Is Admission after
No
Diploma
Joining Date
08-07-2013
Fee Receipt
No.
Quota
Government Quota

Residential Number: , MobileNumber: 9730359922, EmailAddress: mayurgharat21@gmail.com

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Address For Correspondence

Address:- Location:- City:- NA Pincode:- 401404 Taluka:- Deolgaon Raja District:- Thane
Parent / Guardian Details
Parent's name

Gharat

Dattatray

Age

Relation with Applicant Father

Parmanent Address
Is Father Alive

52(yrs)

Profession

Teacher

Mayur nivas Location:- char rasta City:- Palghar Pincode:- 401404 Taluka:- Palghar District:Thane
Annual Income 60000.00
Yes

Hostel Information
Name of Landlord /
Hostel

Hostel Admission
Date

Hostel Type

Is Mess Service Available?

Hostel/ Landlord
Address

No

Rent Per Month

0.00

Hostel/Landlord
Contact Details

Is Studying in night school

No

Document Details
Caste Certificate No

826

District Issuing Thane

Office

Taluka Issuing
Office

Dahanu

Caste Validity
Certificate No

N.A

District Issuing Thane

Office

Scrutiny
Committee No

N.A

Issued in

University
Registration No

70800172G

Income Certificate
1060
No
Student Bank Account Details
Bank Name

BANK OF MAHARASHTRA

Branch Name

PALGAR

IFSC Code

MAHB0000195

2012

Bank
Account No

68005104908

MICR Code

NOT AVAILABLE

Document Attached
EID document xerox
SSC Mark Sheet
Non Creamy Layer Certificate
Caste Validity Certificate
I-card Size Photo
Marksheets
Income Proof Income Certificate Issued by Competant Authority
Caste Certificate Issued by Competant Officer
Declaration
The information furnished by me is complete and correct. I bear the complete responsibility for all the above
information.
Applicant's Signature

_______________________

Principal's Signature

_______________________

Applicant Parent's Signature

_______________________

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