Shri Vile Parle Kelavani Mandal's

Mithibai College of Arts, Chauhan Institute of Science & Amrutben

Jivanlal College of Commerce & Economics (Autonomous)
Bhakti Vedanta Swami Marg, Vile Parle (West) , Mumbai - 400 056
Application No. Tel No. 4233 9000 / 01
600964790 Admission for Junior College :- Acad .Year 2024-2025

Stream Applied For* : H.S.C.- Commerce (MBC)

Passed 10th Std. form* : CBSE
Admission Category* : CAP - Open

Final
Have You Opted for French/Sanskrit at 10th Board Exam : YES

Name as Per Govt. File : KANAK CHANDAK

Personal Details :
Salutation First Name Middle Name Last Name Mother's Name
Ms. KANAK CHANDAK PRIYANKA
Gender : Female Date of Birth : 11.08.2008
Nationality : IN Place of Birth : DURG
Mother tongue : HINDI Blood group : B+
Religion : Hindu UDISE No. : 22100700310
Social Class : General Category (GN) Caste : NONE

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Aadhar No. : 3344XXXX99 Disability :
Aadhar Name : KANAK CHANDAK Online Unique ID Code : MU242160553
Saral Id : Height : 162.5
Weight : 45
Local Address
Address Line 1 : GANJ PARA DURG Address Line 2 : AMAR HEIGHTS
Address Line 3 : State : Chhattisgarh
Pin code : 491001 City : DURG
Telephone No. : Mobile No. : 07898411808
E - Mail ID : [email protected] Nearest Railway Station : DURG

Permanent Address
Address Line 1 : GANJ PARA DURG Address Line 2 : AMAR HEIGHTS
Address Line 3 : State : Chhattisgarh
Pin code : 491001 City : DURG
Nearest Railway Station : DURG

10th Std. Details : 10th Std. CBSE Board Exam Seat No. :- 1392938
Merit Score Applicant Status : Fresher
Passing As per Govt. Online
Passing Month Name of School Address of School
Year Form

05 2024 452.00 DELHI PUBLIC SCHOOL BHILAI

Students who have not taken Maths in 10th standard will not be allowed to opt for Maths in Mithibai.
Application No. 600964790 Page 1 of 6
 Information related to admission to XI th Std.
Note :Optional Subjects/languages will be allotted to a student on the basis of Merit & availability of seats.
Students who have opted French or entire Sanskrit as a language subject at 10th std. will be given first
preference to French if opted.
( Language /Optional Subject Preference once Chosen will not be altered later)
Preference 1 : INFORMATION TECHNOLOGY (I.T) Preference 2 : FRENCH
Preference 3 : HINDI Preference 4 : MARATHI
Preference 5 : GUJARATI

Optional Subject
Preference 1 : Secretarial Practice Preference 2 : Mathematics & Statistics

Parents Details
Father's Details Mother's Details
First Name : GOPAL First Name : PRIYANKA

Final
Middle Name : Middle Name :
Last Name : CHANDAK Last Name : CHANDAK
Occupation : Business Occupation : Housewife
Mobile No. : 09827156311 Mobile No. : 07999143359
E - Mail ID : [email protected] E - Mail ID : [email protected]
Family Income : 600000.00

Father's Office Address Mother's Office Address

Address Line 1 : DURG Address Line 1 :
Address Line 2 : Address Line 2 :
City : DURG City :
Country : India Country : India

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State. : Chhattisgarh State. : Maharashtra
Pincode : 491001 Pincode :
Telephone No. : Telephone No. :

Guardian Details
Guardian Name : AKSHAT CHANDAK
Guardian Occupation : Profession Relationship with Guardian : BROTHER
Guardian E - Mail ID : Guardian Mobile No. : 09300646955
Declaration
We declare that the Information Given above is true and correct. We understand and agree that
management's decision will be final.

Application No. 600964790 Page 2 of 6

 DECLARATION (2023-24) (To be filled by female students only)

Name _____________________________________________________________Roll No_______________Div______________

Form of declaration regarding free education to girls in Std XI & XII in recognized aided Junior college.

The Principal,
Mithibai College of Arts, Chauhan Insititute of Science
& Amrutben Jivanlal College of Commerce and Economics.
Vile Parle (West), Mumbai 400 056.

I, Shri/ Smt. _____________________________________________________________ Parent /Guardian of the student

mentioned herein seeking admission / studying in Std. shown against her / their name (s) hereby declare that I am a resident of
Maharashtra State for not less than 15 years (Photocopy of * documentary evidence must be attached) and that my daughter who is
seeking admission in your college is not the fourth, or subsequent child etc. (See the note below)

·
1.

2.

3.

4.
Final
Sr. No. Name of Child to be written in the order of date of birth Date of Birth Age

I know that if this information is proved to be false, the concession of free education to my ward(s) will be cancelled.
Standard

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· Annual Income from All sources of Previous Year Rs. ____________________________________________________________

Signature of Guardian / Local Guardian Name of the Student & Signature

Date _____________ Residential Address: _______________________________

________________________________________________
________________________________________________
Tel. No: ________________________________________

This information is true & verified, please approve the Girls Freeship concession to the student.

Date: __________________ ________________________________

Signature of Principal

1. Attach photo copies of the First and the Last page of your Ration Card wherein the name of the Parent / Guardian and the child are
mentioned. (Original Ration Card should be carried for verification)
*2.a) Birth Certificate of the student (if born in Maharashtra) or Parent's Service Certificate of last 15 years and Student's
Domicile Certificate b) Telephone Bills / Electricity Bills / Rent Receipt etc. Telephone Bills/Electricity bills/Rent receipt etc.
which establishes authentically that the parent is a resident of Maharashtra state for the last 15 years.

Application No. 600964790 Page 3 of 6

 UNDERTAKING
Date: .............................
To,
The Principal Mithibai College of Arts,
Chauhan Institute of Science and
Amrutben Jivanlal College of Commerce & Economics (Autonomous)
Vile Parle (West), Mumbai - 400 056.

STREAM : - F.Y.J.C. Arts /Commerce/Science

Sir/Madam,

I hereby abide by the rules of college of opting for same subjects in SYJC which are offered to me in FYJC.

Final
Date: _________________________________

Student Parent / Guardian

Name ________________________________ Name____________________________

Signature______________________________ Signature _________________________
Address : - ____________________________
_____________________________________
______________________________________
Tel : - ________________________________

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Application No. 600964790 Page 4 of 6
 Name of the student: _________________________
Address of the student: _____________________
__________________________________________
__________________________________________
__________________________________________
Date:______________________________________
To,
The Principal Mithibai College of Arts,
Chauhan Institute of Science and
Amrutben Jivanlal College of Commerce & Economics (Autonomous)
Vile Parle (West), Mumbai - 400 056.

Sir/Madam,

Final
Subject : - Undertaking related to Attendance.

Regulation 88(1)(a) of Maharashtra Secondary and Higher Secondary Education Board Regulations, 1977 states that the attendance
of the student should not be less than 75 percent of the working days in two different parts, i.e. 1st Term and 2nd Term separately. In
case the student falls to maintain the attendance (for both the terms) as mentioned above, consequently he/she shall not be eligible to
appear the Final Examination of the FYJC / SYJC Board Exams as the case may be.

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I Ms. /Mr. _______________________________________son/daughter of ______________________________________ Studying
in the FYJC/SYJC _________ Class / Div. ____________bearing Roll No. ___________________affirm the same as above.

___________________________________
Name & Signature of the student
( _________________________ )
I _______________________________________parent of__________________________________
Studying in the FYJC/SYJC Class Div. ______________bearing Roll No. __________________ of SVKM's Mithibai College of
Arts, Chauhan Institute of Science and Amrutben Jivanlal College of Commerce & Economics have read the above declaration and
agreed with the same.

I accept the responsibility of keeping track of the attendance of my ward. I, personally and on behalf of my ward, also assure you that
my ward will fulfill the attendance norms as required and specified by Maharashtra Secondary and Higher Secondary Education
Board Regulations, 1977 failing which I am aware that my ward shall not be eligible to appear for the Final Examination of the
FYJC / SYJC Board Exams as the case may be.

_________________________________
Name & Signature of Parent
( _________________________ )

Application No. 600964790 Page 5 of 6

 Final
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Application No. 600964790 Page 6 of 6