GOVERNMENT OF MAHARASHTRA

STATE COMMON ENTRANCE TEST CELL

8th Floor, New Excelsior Building,Mumbai�400051.(M.S.).
Printable Application Form for Admission to Direct Second Year of Four Year Degree Courses in
Engineering & Technology for the year 2018-2019
Mode of Application : Diploma Application ID : DSE18111719 Version : 1
Personal Details
Full Name AKOLKAR VAIBHAV RAMESH
Gender Male Date of Birth 28-02-2000
Caste-Category (Sr.No.) OPEN Religion Hindu
Mother Tongue Marathi Family Income ( ) 15,001 - 50,000
Nationality Indian PWD Type N.A.
Maharashtra State Candidate -
Type of Candidature Orphan No
Type A
Religious Minority / Linguistic Minority N.A. Applied For TFWS Yes
Defence Type N.A.
706082632484
I, the holder of Aadhaar Number [706082632484 ], hereby give my consent to State CET Cell to obtain my Aadhaar number for authentication with
Aadhaar Number
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 Aurangabad
District from which candidate has Passed Diploma Aurangabad
Diploma Details
Diploma Status Passed Enrollment No 1510920051
Course Civil Engineering
Institute Type MSBTE Affiliated
Institute Name Shree Yash Pratishthan, Shree Yash Polytechnic, Satara Tanda, Aurangabad.
English Medium Yes Pattern : Semester Diploma Roll/Seat No. 544828
Qualification Details
Examination Marks Obtained Marks Out Of Percentage
Diploma Final Year/Semester 1035 1650 62.73
10th/S.S.C. Aggregate 386 500 77.20
10th/S.S.C. Mathematics 80 100 80.00
10th/S.S.C. Science 61 100 61.00
10th/S.S.C. English 66 100 66.00
Payment Details
Payment Date : 08-07-2018 Amount( ) : 800 /-
Note : Candidate shall carry printed copy of Application Form, Original documents and one set of Xerox copies of the required documents. FC shall verify all documents from
Original and put FC stamp with date & Signature on Xerox copies and return original and verified documents along with Receipt-cum-Acknowledgement of application form.
(Candidate shall submit FC stamped & verified set of documents to ARC for re-verification after the allotment and then to the Institute at the time of reporting).
Note: List of Documents Required at the time of Document Verification and Confirmation at Facilitation Center (Do not attach Xerox Copies)
Sr. No. List of Documents Required at the time of verification at FC.
1 The School Leaving Certificate indicating the Place Of Birth In Maharashtra
2 Certificate of the Indian Nationality of the candidate
3 Statement of marks obtained at 10th/SSC or its Equivalent Examination
4 Statement of marks obtained at the Diploma Examination for each attempt in Final Year/Semesters.
5 Income Certificate of Parents having Annual Income upto 6 Lacs.

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 Four Year Degree Courses in Engineering & Technology for the academic Year 2018 - 2019. 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 : 10-08-2018 Place :   Signature of the Candidate

(AKOLKAR VAIBHAV RAMESH)
Last modified by : FC200801 Printed By : DSE18111719
Last modified on : 10-07-2018 12:52:19 PM Printed On : 10-08-2018 09:26:19 PM

Note: The Candidates are required to produce the documents in original for verification and Confirmation of Application Form at FC. It is mandatory on the Candidates part to
produce all original documents in support of the claim made by the Candidate in the application form. Candidates are advised to keep the necessary documents ready at the time
of Documents verification stage as per the notified schedule.All FCs shall remain open on all days including holidays and Sundays during the schedule between 10.30 A.M. to
5.30 P.M.