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For Office Use
Batch: Scrutiny Payment: Online/DD PI
Only Serial:
PILLAI HOC COLLEGE OF ENGINEERING AND TECHNOLOGY,RASAYANI (822)
Near Hoccol ony Rasayanivia panvel. Panvel Application No :
University of Mumbai 2818648
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
Academic Year: 2022-2023
Regular
APPLICATION FORM
Course Applied for : B.E.(with Credits) - Regular - CBCS - Mechanical Engineering - S.E. C-Scheme Sem III PRN:
(BECBCS1001)
Application Date : 29/11/2022 Payment Category :
1.Personal Information
Candidate's Name(Regional) : प्रितेश उमेश मनोरे
Candidate's Name as printed on Mark PRITESH UMESH MANORE
sheet : [*This name will appear on all University records/documents]
Father's/Husband's Name : UMESH Mother's Name : UTKARSHA
Marital Status : UnMarried Mother Tongue : Marathi
Place Of Birth : PEN Gender : Male Date of Birth (DD/MM/YYYY) : 26/09/2003
Blood Group : APositive Religion : Hindu Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
State : Maharashtra District : Raigad Tehsil : Pen City/Town/Village : PEN Location Area : Rural
Address (House
PLOT NO. 403 MHADA COLONY PEN Pin Code : 402107
no,street/area/suburb etc.) :
Permanent Address :
State : Maharashtra District : Raigad Tehsil : Pen City/Town/Village : PEN Location Area : Rural
Address : PLOT NO. 403 MHADA COLONY PEN Pin Code : 402107
Contact details
Mobile Number 8983832479 Email ID: umeshmanore888@gmail.com
2.Legal Reservation Information
Category Type :
Category : OBC Sub Category : WANI
Reserved
Is Guardian from EBC (Economic Backward
Is Specially Abled? No
Class)? Yes
3.Social Information(Additional Inforamtion)
Economically Backward Class
Paper Selected for:
Sem III
MEC301 - Engineering Mathematics-III MEC302 - Strength of Materials
MEC303 - Production Processes MEC304 - Materials and Metallurgy
MEC305 - Thermodynamics MEL301 - Materials Testing
MEL302 - Machine Shop Practice MEPBL301 - Mini Project – 1A
MESBL301 - CAD –Modeling
Sem IV
MEC401 - Engineering Mathematics-IV MEC402 - Fluid Mechanics
MEC403 - Kinematics of Machinery MEC404 - CAD/CAM
MEC405 - Industrial Electronics MEL401 - Industrial Electronics
MEL402 - Kinematics of Machinery MEL403 - Python Programming
MEPBL401 - Mini Project – 1B MESBL401 - CNC and 3-D Printing
Medium of Instruction : English
4.Guardian Information
Occupation of Guardian : Service Annual Income of Guardian : 50000
5.Educational Details
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Month
Name of Name of Board/University and and Year Exam Certificate Mark
Name of School/College Out of CGPA %
Examination State of University of Seat No. No. Obtained
Passing
MAHARASHTRA STATE BOARD
OF SECONDARY AND HIGHER CARMEL HIGH June
Std 10th A196742 137793 310.00 500.00 -- - -- 62.00
SECONDARY SCHOOL PEN 2019
EDUCATION,Maharashtra
PILLAI HOC
Diploma : COLLEGE OF
Maharashtra State Board of
MECHANICAL ENGINEERING AND July 2022 126626 19156174 1515.00 1950.00 -- - -- 77.69
Technical Education,Maharashtra
ENGINEERING TECHNOLOGY
RASAYANI
Your Last Qualifying Exam: MECHANICAL ENGINEERING
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Passing Certificate of Std 12th / Statement of Marks of Std 12th OR Original Passing Certificate /Statement of Marks of Last Qualifying Exam like
degree,diploma,etc.
Certificate of Caste with Category.
Passing Certificate of Std 10th.
Leaving Certificate.
Non Creamy Layer Certificate.
Domicile Certificate.
Mark/Grade Statement of Semester-I
Mark/Grade Statement of Semester-II
Mark/Grade Statement of Semester-III
Mark/Grade Statement of Semester-IV
Mark/Grade Statement of Semester-V
Mark/Grade Statement of Semester-VI
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 Application No :2818648 (PRITESH UMESH MANORE) 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 )
For College/Institute/Study Center Use Only
Designation Remarks / Particulars / Recommendations Signature and Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: INR Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Tue Nov 29 2022 19:19:50 GMT+0530 (India Standard Time)
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