220370/SHIVAJI/17/1

Shivaji College
B.A (Hons) Geography

Application under 1st Cut-Off (Merit Based)

Form 180193491 Applicant's MONICA Gender Female

Number Name

Transaction 18060524454518 Date of Birth 7 January 2001 Nationality Indian

Id

Result Status Passed Contact monica12419@gmail.com

/ 9990277797

Year of 2018 Mother's Name MEENA Father's / NARESH

Passing Guardian's
Name

Board Roll 9725699 Correspondence HNO-77, ROAD NO-2, B- Permanent HNO-77, ROAD
Number Address BLOCK,, Address NO-2, B-BLOCK,,
POCHANPUR POCHANPUR
Education CENTRAL BOARD EXTENSION , DWARKA EXTENSION ,
Board OF SECONDARY SECTOR 23, DWARKA SECTOR
EDUCATION , 23,
-110077, ,
Hindi upto Class XII India -110077,
Language India
Studied
Upto?

Family Not Applicable Category Unreserved Ward Quota Not Applicable

Income Minority Category: Not
Applicable

PwD Not Applicable CW Category Not Applicable Kashmiri Not Applicable

Category Migrant
Category

Father's / Agriculture Father's / Father's /

Guardian's Guardian's Guardian's
Occupation Office Address Mobile
Number

Mother's Home Maker Mother's Office Mother's

Occupation Address Mobile
Number

Bank Details

Name of SURENDER Account 91452010009219 Name of SYNDICATE IFSC SYNB0009145

Account SINGH TAHLAN Number the Bank BANK Code:
Holder

Subjects taken in Board Examination

Subject Name Maximum Marks Marks Obtained

English Core 100 87

Geography 100 87

Economics 100 87

Hindi Elective 100 95

Political Science 100 98

Physical Education 100 90

Uploads

Photograph: Yes, Signature: Yes, Date of Birth Certificate: Yes, Class 12th Marksheet: Yes, Category Certificate: Not
Applicable, Income Certificate: Not Applicable, Kashmiri Migrant Quota Certificate: Not Applicable CW Quota Certificate: Not
Applicable

********************************************** For Office Use Only **********************************************

_______________________ _______________________ _______________________ _______________________

(Authorised Signatory) (Authorised Signatory) (Authorised Signatory) (Authorised Signatory)

The applicants shall be required to produce following documents in original (Check list for Applicant)

1. Class X Board Examination Certificate 2. Class X Marks-Sheet

3. Class XII Marks-Sheet 4. Class XII Provisional Certificate / Original

Certificate

5. Character Certificate (recent) 6. SC/ST/PwD/CW/KM Certificate (in the name of the

candidate) issued by the competent authority

7. OBC (Non-Creamy Layer) Certificate (in the name of 8. At least two passport size self-attested
the Candidate) issued by competent authority photographs.

9. Transfer Certificate from school / college as well as Migration Certificate from Board / University are required from those
students who have passed senior secondary exam from outside Delhi

The College/University will accept self-attested copies of documents / papers provided by the students. It is made clear that
if any false attestation / falsified records are detected, the student will be debarred from attending any course in the
University / or its Colleges for next five years and in addition, a criminal case under relevant sections of IPC (viz. 470,471,474
etc.) will be instituted against him/her.

Declaration by the Applicant

I declare that the certificates and testimonials submitted by me are authentic and that the above information is correct to the
best of my knowledge. I will be liable for cancellation of my admission if any of my document(s) is found faked/ forged. I
understand that I will be filling an on-line anti-ragging affidavit on confirmation of my admission.

_________________________________ _________________________________ _________________________________

(Date) (Signature of Parent/Guardian) (Signature of Applicant)

********************************************** For Office Use Only **********************************************

_______________________ _______________________ _______________________ _______________________

(Authorised Signatory) (Authorised Signatory) (Authorised Signatory) (Authorised Signatory)