Application Checklist

Counselor Name Branch

Country

1
Special Instructions for mentioning name of the students - As per the passport, If the student only have Give
Family Name while filing the Application.
Middle
Given Name Arpit Surname / Family Name
Name
Date of
Marital Status Single 9/17/1997 Student’s Citizenship
Birth
Country of Issue
Passport No T7969279 Issue Date 8/23/2019 Expiry Date 8/22/2029
(Passport)
Alternate Email
Email ID [email protected]
id

Permanent Address
A-1202, Dream Heights CHS, Plot no 28, Sector 19, Kharghar, Navi Mu
(According to the Passport)

Adhaar Card No. 900375576989

Emergency Contact
Given Name Mr. Prakash C Shukla
2 Surname / Family Name Shukla
Relationship with Applicant Father
Phone No 9867557280
Email ID [email protected]

Education
Start Date
Submitted (Only School/ College/ University End Date (DD-MM-
Level of Education Board (DD-MM-
Yes/No) Name YYYY)
YYYY)
Secondary Education
Senior Secondary (Year 10th) CBSE Yes Greenfingers Global School 2013 5/25/2013

Higher Secondary (Year DAV International School 2015

CBSE Yes 5/25/2015
3 12th)
Diploma (If Applicable)
Tertiary Education
Bachelors (Sem wise or Mumbai Dr. DY Patil College Of Law 2015
Yes 2020
year wise marksheets) University

Masters / PGDM (Sem wise ICFAI Business School 2020

Yes 2022
or year wise marksheets)

****PLEASE MENTION IF ANY BACKLOGS

English Language Proficiency Test (IELTS / PTE / TOEFL)

4 Exam Taken Name Date of Test Taken Expiry Date of the Test
Reading

Any gap in education

5 Please declare if any gap in academic
History or employment history for more than 6 months. Please declare and explain it below or else mention not applicable. You can co
Explanation:

Work Experience Yes / No (If Yes, please fill the below mentioned details)
If yes, Please mention the work experience chronologically from present to Past or attach detailed resume mentioning work experienc
resume attached.
Company Designation
6
ManpowerGroup Management Trainee
Future Generali Life Insurance Summer Intern
 Any Visa Rejection from any country Yes / No
7
If yes, attach visa rejection letter

Is this case is dependent / spouse case Yes / No (If Yes, please fill the below mentioned details)
Name of Dependent (As per passport) Relationship with m
8 Dependent 1 NA
Dependent 2 NA
Dependent 3 NA

If the student holds a visa, visa grant letter (if yes, specify
Yes / No (If Yes, please atta
9 country)
Country and other details N.A

Referee / LOR Provider Details

Name Designation Company / Institution Email Mobile No.
10

Source of Funding (Mark Yes for the Applicable Source)

Self
Bank Loan Yes
11 Parents Yes
Family in India Yes
Relative Abroad
Employer
Others (Specify)

12 **** IMPORTANT Have you made any application to any Universities on your own or through other If yes kindly mention the details
DECLARATION Agents
University Name Campus Intake Month
N.A

Document Checklist Delete any 2 of the options as applicable

1 Passport Yes
2 Resume Yes
3 10th and 12th makrsheet Yes
4 Bachelors marksheet semester wise Yes
5 Degree Certificate Yes
6 Masters marksheet Yes
7 Degree Certificate Yes
8 IELTS/ TOEFL/ PTE No
9 Offer letter/ Experience letter / Internship letter Yes
10 Letter of recommendation Yes / No/ NA
11 Statement of purpose (Customized for each applying University) Yes / No/ NA
12 Any Previous Visa rejection letter No
13 If the student holds a visa, visa grant letter (if yes, specify country) N.A
14 Adhaar Card Yes
15 Birth Certicifate (In English) Yes / No/ NA
16 Name Change (If any, affidavit to be attached) No

List of Shortlisted Universities to Apply

Sr.
University Name Campus Intake Month Intake Year Course Name Course Link Course Code
No.

1
2
3
4
5
6
anch

y have Given Name, then write the same as Surname /

Shukla Gender Male

Place of Mirzapur, Uttar

Indian
Birth Pradesh
Disability (If
India N.A
Any)

Phone No. 7738387280

arghar, Navi Mumbai, 410210

Shukla

0
gmail.com

Medium of
Scores
Education

66.50% English

75% English

55% English

8.43 CGPA English

TOEFL)
Scores
Writing Listening Speaking Overall

le. You can copy paste the explanation from SOP as well.

ork experience. Please confirm after answering ‘yes’ that detailed

Start Date (DD-MM-YYYY) End Date (DD-MM-YYYY)
7/21/2022 Present
2/23/2021 5/24/2021
Yes / No

nship with main Applicant

NA
NA
NA

es, please attach visa grant letter)

Address

tion the details here below:

Intake Year Course Name Self / Agency Applied Through

able

*Application
Data
Fee waiver Authority
Protection User Id Password
Code (If Letter
Form
Applicable)*