For Office Use
Batch: Scrutiny Payment: Online/DD PI
Only Serial:
Pragat Samajik Shikshan Society Sanchalit Dr Babasaheb Ambedkar Science Mahavidyalya (893)
Application No :
University of Mumbai
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
2368435
Academic Year: 2023-2024 Regular
APPLICATION FORM
Course Applied for : B.Sc. (I.T.)(with Credits) - Regular - Rev16 - T.Y. PRN:2021016400399233
B.Sc. (I.T.) Sem V [1S00255] (42300003)
Application Date : 17/07/2023 Payment Category : 13
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed SHAH RAZAWARIS ABDUL KALAM
on Mark sheet : [*This name will appear on all University records/documents]
Mother's
Father's/Husband's Name : ABDUL KALAM SALEHA
Name :
Mother
Marital Status : UnMarried
Tongue :
Place Of Birth : Vasai Gender : Male Date of Birth (DD/MM/YYYY) : 07/07/2003
Blood Group : Religion : Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Palghar Tehsil : Vasai City/Town/Village :
Available
Address (House
no,street/area/suburb 101,Above Kgn Shop,Opp.Parshva Krupa Bld Suyog Nagar,Vasai(West) Pin Code : 401202
etc.) :
Contact details
Mobile
918007117510 Email ID:
[email protected]Number
2.Legal Reservation Information
Category Type :
Category : GEN
Open
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem V [1S00255]
53701 - Software Project Management 53702 - Internet of Things
53703 - Advanced Web Programming USIT5P1 - Project Dissertation
USIT5P2 - Internet of Things Practical USIT5P3 - Advanced Web Programming Practical
53704 - Artificial Intelligence USIT5P4 - Artificial Intelligence Practical
53706 - Enterprise Java USIT5P6 - Enterprise Java Practical
Sem VI [1S00256]
88701 - Software Quality Assurance 88702 - Security in Computing
88703 - Business Intelligence USIT6P1 - Project Implementation
USIT6P2 - Security in Computing Practical USIT6P3 - Business Intelligence Practical
USIT6P6 - Advanced Mobile Programming 88704 - Principles of Geographic Information Systems
USIT6P4 - Principles of Geographic Information Systems 88707 - Cyber Laws
Practical
Medium of Instruction : English
4.Guardian Information
Occupation of Guardian : Service Annual Income of Guardian : 95000
5.Educational Details
Month Exam
Name of Name of Board/University Name of Certificate Mark Out
and Year Seat CGPA %
Examination and State of University School/College No. Obtained of
of Passing No.
MAHARASHTRA STATE
BOARD OF SECONDARY
Std 10th June 2019 -- -- 287.00 500.00 -- - -- 57.40
AND HIGHER SECONDARY
EDUCATION,
MAHARASHTRA STATE
Std 12th 12Th BOARD OF SECONDARY
June 2021 -- -- 414.00 600.00 -- - -- 69.00
(Commerce) AND HIGHER SECONDARY
EDUCATION,
Your Last Qualifying Exam:
7.Other Information
Would you like to apply for Hostel accommodation required NA
DECLARATION
I hereby declare that all the information furnished by me in this application form is true, complete and correct to the best of my
knowledge and belief. I do understand that I need to obtain and produce all the required documents. I admit to having
understood what constitutes ragging and sexual harassment. I have read the guidelines related to the same. I hereby affirm that if
found guilty of ragging or sexual harassment I am liable for punishment according to the university regulations.
Place : Date :
( Signature of the Candidate )
Document printed on Fri Aug 25 2023 10:45:34 GMT+0530 (India Standard Time)
