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For Office Use

Batch: Scrutiny Payment: Online/DD PI

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Sydenham Institute of Management Studies and Research and Entrepreneurship

Application No
Education (235)
`B` Road. Mumbai :
University of Mumbai
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
2877378
Academic Year: 2022-2023 Regular
APPLICATION FORM

Course Applied for : M.M.S.(with Credits) - Regular - Rev16 - F.Y. M.M.S. Sem I (-) PRN:
Application Date : 14/12/2022 Payment Category :
1.Personal Information
Candidate's Name(Regional) : सुधांशु मणि त्रिपाठी
Candidate's Name as printed on Mark SUDHANSHU MANI TRIPATHI
sheet : [*This name will appear on all University records/documents]
SHASHI KANT
Father's/Husband's Name : Mother's Name : MANJU
TRIPATHI
Marital Status : UnMarried Mother Tongue : Hindi
Place Of Birth : Amethi Gender : Male Date of Birth (DD/MM/YYYY) : 01/07/1999
Blood Group : BPositive Religion : Hindu Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Uttar Pradesh
Address For Correspondence :
State : Maharashtra District : Pune Tehsil : Haveli City/Town/Village : Pune Location Area : Urban
Address (House
Qtr No 50/10 , Ghorpadi Lines Ghorpadi , Pune Camp Pin Code : 411001
no,street/area/suburb etc.) :
Permanent Address :
City/Town/Village :
State : Uttar Pradesh District : Amethi Tehsil : Tiloi Location Area : Rural
Semrauta
Address : C/O Sri Shashi Kant Tripathi , Vill-Tiwari Pur Bada,Post Semrauta Pin Code : 229126
Contact details
Mobile Number 7775064917 Email ID: [email protected]
2.Legal Reservation Information
Category Type : Open Category : GEN
Is Guardian from EBC (Economic Backward
Is Specially Abled? No
Class)? No
3.Social Information(Additional Inforamtion)
Kashmir Migrant
Paper Selected for:
Sem I
UMMSI.1 - Perspective Management UMMSI.2 - Financial Accounting
UMMSI.3 - Business Statistic UMMSI.4 - Operations Management
UMMSI.5 - Managerial Economics UMMSI.6.1 - Effective and Management Communication
UMMSI.6.7 - Negotiation and Selling Skills UMMSI.6.9 - Informational Technology for Management
Sem II

UMMSII.1 - Marketing Management UMMSII.2 - Fainancial Management

UMMSII.3 - Operation Reaserch UMMSII.4 - Business Reserch Methods
UMMSII.5 - Human Resource Management UMMSII.6.1 - Legal & Task Aspects Of Business
UMMSII.6.10 - Intellecture Capital And Patenting UMMSII.6.7 - Enterpreneurship Management

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Service Annual Income of Guardian : 500000
5.Educational Details

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Month
Name of Board/University Name of and Year Exam Seat Certificate Mark
Name of Examination Out of CGPA %
and State of University School/College of No. No. Obtained
Passing
CENTRAL BOARD OF
KENDRIYA May 7.8 -
Std 10th SECONDARY 5273267 1192262 - - -
VIDYALAYA 2014 b1
EDUCATION,Uttar Pradesh
CENTRAL BOARD OF
KENDRIYA May
Std 12th Science SECONDARY 4644443 0896247 386.00 500.00 -- - -- 77.20
VIDYALAYA 2016
EDUCATION,Maharashtra
SINHAGAD
Degree : Bachelor Of Savitribai Phule Pune July 8.27 -
ACADEMY OF B150431040 -- - - -
Engineering(Mechanical) University,Maharashtra 2021 a+
ENGINEERING
Your Last Qualifying Exam: Bachelor Of 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.

Passing Certificate of Std 10th.

Leaving Certificate.

Domicile Certificate.

Self affidavit regarding gap in academic year (Gap Certificate).

Statement of Marks of First Year/ Semester.

Statement of Marks of Second Year/ Semester.

Statement of Marks of Std 10th.

Affidavit regarding Anti Ragging.

Birth Certificate.

Original Passing Certificate of last qualifying exam.

Original Statement of Marks for First Year/Semester.

Original Statement of Marks for std. 12th.

Passing Certificate of Std. 10th.

Passing Certificate of Std. 12th/Statement of Marks of std.12th.

School/College Leaving Certificate.

Self-affidavit regarding Gap in AY (Gap Certificate) –Rs.50/- or Rs.100/- stamp paper Notarized.

Statement of CET/Certificate of CET.

Statement of Marks of First Year/Semester.

Statement of Marks of Second Year /Semester.

Statement of Marks of Std. 10th.

T.C. Certificate.

Third Year Mark Sheet

Mark/Grade Statement of Semester-I

Mark/Grade Statement of Semester-II

Mark/Grade Statement of Semester-III

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Mark/Grade Statement of Semester-IV

Mark/Grade Statement of Semester-V

Mark/Grade Statement of Semester-VI

Mark/Grade Statement of Semester-VII

Mark/Grade Statement of Semester-VIII

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 :2877378 (SUDHANSHU MANI TRIPATHI) 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 Wed Dec 14 2022 14:37:31 GMT+0530 (India Standard Time)

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