Janata Shikshan Sanstha’s
KISAN VEER MAHAVIDYALAYA, WAI (SATARA)
(Afffilited to Shivaji University, Kolhapur)
No. :
ADMISSION FORM
College Code : 077
Kindly read important notes before
filling-in form :
Use Ball Pen to fill in the form and Do
Not Overwrite
Fill in all fields in CAPITALLetters only.
Strike off whichever is NOT applicable.
Ph. (02167) 220130
E-mail : [email protected]
Class
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Roll No.
E.B.C.
Paying
P.T.C.
STC
B.C. Sch
OBC-Sch
Date :
B.C.
Freeship
OBC
Freeship
Reciept No.
/
Signature
of Student
/ 2015

1. Personal Information Section
Last Name
First Name
Middle Name
Name of the Student
(as per 10th Passing Certificate)
Name of the Student
(in Devnagari Script) _amR>rV
Father / Husbands Name
Mothers Name
Marital Status : Married / Unmarried
Gender :
Male / Female
Date of Birth (DD / MM / YY)
/
/ 19
Place of Birth :
Blood Group :
Minority Detail :
2. Legal Reservation Information Section
Category : Open / Reserved
If Reserved : SC / ST/ NT-A, B, C / OBC / SBC :
Religion :
Caste :
Sub-Caste :
If Physically Challenged : Y/N
3. Address for Correspondance :
Tal :
Dist :
PIN CODE
4. Permanent Address :
Tal :
Dist :
PIN CODE
Phone :
Email :
Mob. No :
Adhar No.
5. Educational Details Section :
Details of Marks Obtained at the last Examined Passed
Marks Out of
Name of Examination
Subjects
Obtained
1
Name of Board / University
2
Name of School / College
3
Roll No.
4
Date of Passing
5
6
Exam Seat No.
7
Exam Center
Percentage :
Total :
% Grade :
6. Selected / Opted Papers Section :
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OPTIONAL SUBJECT
COMPULSORY SUBJECT
1)
2)
1) ENGLISH
3)
4)
2)
5)
3)
6)
Name and Signature of Subject
Committee Member
Sign.
Assist. / Associate Prof.
Parents / Guardinas Occupation - Farmer / Labourer / Service / Business / Other Parents / Guardinas Annual Income for Year 2014-2015
Declaration by Student
I hereby declare that, I have read the rules related to admission and the information filled in by me in this form is
accurate and true to the best of my knowledge. I will be
responsible for any descrepancy, arising out of the form
signed by me and I dundertake that, in absence of any
document the final admission will not be granted and / or
admission will stand cancel.
Date : /
Rs.
Declaration by Guardian
I have permitted my son / daughter / ward to join your
college. The information supplied by him / her is correct
to the best of my knowledge. I have acquainted myself
with the rules and fees, dues to my son / daughter / ward
and to see that he / she observes.
Date : /
/ 2015
Parent’s / Guardian’s
/ 2015
Signature’s
Student Signature’s
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Cleark
Admission Committee
PRINCIPAL
Janata Shikshan Sanstha’s
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KISAN VEER MAHAVIDYALAYA, WAI
(Dist. Satara)
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(Afffilited to Shivaji University, Kolhapur)
Tel. (02167) 220130, 221972
E-mail : [email protected]
College Code : 077
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Identity Size Photo
Janata Shikshan Sanstha’s
`oWo Am`H$mS>© gmB©O
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{MH$Q>{dUoMm Amho.
KISAN VEER MAHAVIDYALAYA, WAI
(Afffilited to Shivaji University, Kolhapur)
MERIT LIST FORM
Q>mMUr _mê$ Z`o.
To,
The Principal,
Kisan Veer Mahavidyalaya, Wai
Dist. Satara.
Sir,
I wish to apply for adimission to the June 2015
Class of your College. I here by
agree to abide by the rules and regulations of the College. I undertake that so long as I am a student of College, I
will do nothing that will interfere with its discipline and order.
In case I am admitted, I agree to pay all the fees as specified in the Prospectus and will attend the college
regularly from June 2015. If fail to do so, I forfeit all claims on the admission and admission fees.
Date :
/
Yours obediently
/ 2015
(Signature of the Student)
PERSONAL INFORMATION :
Last Name
First Name
Middle Name
Name of the Student
Name of the Student
(in Devnagari Script)
_amR>rV
Mobile No.
EBC / OBC-Sch. / OBC - Freeship / BC-Sch./
Email :
Special Category : Ex-service / Freedom Fighter /
BC-Freeship / STC / PTC / Paying.
Handicapped
Male / Female :
Caste :
Religion :
Catagory :
Details of Last Exam Passed (Class) :
Month :
Passing Year :
Seat No.:
Board / University :
Previous College Name : (Same/Other) :
Total Marks Obtained =
out of -
Result - Pass / Fail ATKT
Subjects (J«wn) -
(Signature of the Student)
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