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    2nd Year Mumbai University

    Uploaded by

    tejasshirsath62
    Hsjsje

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    © All Rights Reserved
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    2nd Year Mumbai University

    Uploaded by

    tejasshirsath62
    22 views2 pages
    Hsjsje

    Original Title

    2nd year Mumbai University

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    © © All Rights Reserved

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    Hsjsje

    Copyright:

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    Download as pdf or txt
    22 views2 pages

    2nd Year Mumbai University

    Uploaded by

    tejasshirsath62
    Hsjsje

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    For Office Use

    Batch: Scrutiny Payment: Online/DD PI

    Serial:
    Only

    Bharati Vidyapeeth College of Pharmacy, Navi Mumbai (377)


    Application No :
    University of Mumbai 2897127
    M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
    Academic Year: 2023-2024 Regular
    APPLICATION FORM

    Course Applied for : M. Pharm.(with Credits) - Regular - Rev16 -


    PRN:2022016402490492
    M.Pharm.Part - II Sem III (-)

    Application Date : 21/09/2023 Payment Category : 37


    1.Personal Information
    Candidate's Name(Regional) :
    Candidate's Name as printed SHIRSATH TEJAS SANJAY
    on Mark sheet : [*This name will appear on all University records/documents]
    Mother's
    Father's/Husband's Name : SANJAY JYOTI
    Name :
    Mother
    Marital Status : UnMarried
    Tongue :
    Place Of Birth : BAHIRGAON Gender : Male Date of Birth (DD/MM/YYYY) : 16/09/2000
    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 : Aurangabad Tehsil : Kannad City/Town/Village :
    Available
    Address (House
    no,street/area/suburb MU-PO BAHIRGAON KANNAD Pin Code : 431103
    etc.) :
    Contact details
    Mobile
    919527904810 Email ID: [email protected]
    Number
    2.Legal Reservation Information
    Category Type :
    Category : OBC
    Reserved
    Is Guardian from EBC (Economic
    Is Specially Abled? No
    Backward Class)? No
    3.Social Information(Additional Inforamtion)
    Not Applicable
    Paper Selected for:
    Sem III
    MRM 30 1T - Research Methodology and Biostatistics* MRM 302T - Journal club
    MRM 303T - Discussion / Presentation (Proposal Presentation)
    Sem IV

    MRM 401T - Journal club MRM 402T - Discussion / Presentation (Proposal


    MRM 403T - Research work and Colloquium Presentation)

    Medium of Instruction : English


    4.Guardian Information
    Occupation of Guardian : Laborer Annual Income of Guardian : 40000
    5.Educational Details
    Name of
    Month and Exam
    Board/University Name of Certificate Mark
    Name of Examination Year of Seat Out of CGPA %
    and State of School/College No. Obtained
    Passing No.
    University
    Std 10th MAHARASHTRA March -- -- 404.00 500.00 -- - -- 80.80
    STATE BOARD OF 2016
    Name of
    Month and Exam
    Board/University Name of Certificate Mark
    Name of Examination Year of Seat Out of CGPA %
    and State of School/College No. Obtained
    Passing No.
    University
    SECONDARY AND
    HIGHER
    SECONDARY
    EDUCATION,
    MAHARASHTRA
    STATE BOARD OF
    SECONDARY AND February
    Std 12th 12Th (Science) -- -- 469.00 650.00 -- - -- 72.15
    HIGHER 2018
    SECONDARY
    EDUCATION,
    Degree : B-
    September
    PHARMACY(Bachelors) -- -- 4135.00 5250.00 -- - -- 78.76
    2022
    Degree
    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 Thu Sep 21 2023 14:55:49 GMT+0530 (India Standard Time)

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