Session 2020-2021

HISLOP COLLEGE College Code

:HCN

Temple Road,Civil Lines,Nagpur 440001

For College Course Applied to: B.SC - II (SEM 3) Registration No.

use only 878663

Admission Date :

01. Personal Information Section

LAST NAME FIRST NAME MIDDLE NAME

Name of the Student RATHOD KRUSHNA VASANT

Father's Name VASANT NAMDEV RATHOD

Mother's Name : SAVITA

Marital Status : Saral No. :

Date of Birth : 31/12/2001 Gender : Male

Place of Birth : SINGODA Blood Group : AB+

Grandfather Name : Native Place : Singoda

Voter ID Card No. : Organ Donar : NO Medium : ENGLISH

Bank Name : Account No. : Transaction Type : ONLINE

Religion : HINDU Citizenship of : Indian U-DISE No. :

Aadhar Card No. : 214730799520 Driving Licence No. : Minority: YES

02. Address Details

Address for Correspondence: At post shingoda tq kinwat dist nanded

Pin Code : 431804
Singoda

State : maharastra District : NANDED Tehsil : KINWAT City : SINGODA

At post shingoda tq kinwat dist nanded
Permanent Address Pin Code : 431804
Singoda

State : maharastra District : NANDED Tehsil : KINWAT City : SINGODA

03. Contact Details

Student Phone : Parent Phone : 9689838934

Student Mobile No.: 7720066396 Student Email Id: [email protected]

04. Legal Reservation Information Section

Domicile State : MAHARASHTRA Type of Category : Reserve Category Caste Category : VJNT
Sub Caste : BANJARA Phy. Handicapped :
Caste Certificate No. : Learning Disability No. :

05. Social Reservation (Special Category) Information Section

 SR NO. SOCIAL RESERVATION NAME

06. Education Details Section

Name of Name of School Date of Examination Passing Grade / Obt CGPA
Name of
Board / College Passing Seat No. Certificate No. Total Marks %
Examination
Marks

07. Qualifying Exam Details Section

Qualifying Exam Name : HSC (SCI)
College/School Board/ Admission Passing Marks Total Percentage Place Arts/Com Education
Attended University Year Year Obt Marks /Sci Gap

Shri kshetra ajubai 0 0 531 650 81.69 NO

presidency senior and
junior college anwa tq

Qualifying Exam Subject Details

Sr.No. Subject Name Total Marks Obtained Marks

1 MATHEMATICS 100.00 92.00
2 CHEMISTRY 100.00 87.00

08. Subject Details Section

Preferenace : 1 Group Name : PEM

PHYSICS
MATHEMATICS
ELECTRONICS
ENVIROMENTAL STUDIES

09. Attached Documents

Sr No. Name of Documents/Certificates

1 UNDERTAKING FORM COLLEGE WEBSITE(ONLY FOR SEM 3 AND 5)

2 STUDENT AADHAR CARD

3 FATHER OR MOTHER AADHAR CARD

10. Guardian / Parent Information Section

Guardian's/ Parent's Name :

Occupation of the Guardian/Parent : Annual Income of the guardian/Parent :

Relationship of Guardian with applicant : Son Guardian/Parent Phone No. : 9689838934

11. Other Information Section

Mother Tongue : Banjara Employment Status : NO Do you wish to join NCC / NSS: YES

Would you like to apply for Hostel : NO

Hobbies, Proficiency and Other interests : NA

Games and sports participation :

Personal Identification Marks : Mole on left hand

12. Declaration by Student

I hereby declare that, I have read the rules related to admission and the information filled in by me
in this form is accurate and true to the best of my knowledge. I will be responsible for any discrepancy, arising out of the form
signed by me and I undertake that, in absence of any document the final admission will not be granted and / or admission will
stand cancel.

Place :

Date :
Signature of the Student:

13. Declaration by Guardian / Parent

I have permitted my son / daughter / ward to join your college.The information supplied by him / her is
correct to the best of my knowledge. I have acquainted myself with the rules and fees, dues to my son / daughter / ward and see
that he / she observes.

Place :

Date :
Signature of the Guardian/Parent:
14. For College / Institute Use Only
Designation Remarks / Particulars /Recommendations Signature and Date

Admission Clerk
Admission Committee
Accountant / Cashier

Registrar/Office Cash Received : Rs 50.00

Superintendent

REMARK OF THE ADMISSION COMMITTEE

May be admitted to Class_____________________________________________________ Section__________________

May be Rejected____________________________________________________________________________________

Last date of payment of fees __________________________________________________________________________

Admission may be cancelled if the fees are not paid by this date.

Principal Signature of Admission Committee