Shiksha Mandal , Wardha's College Code:

GSCEN
G. S. COLLEGE OF COMMERCE &
Application No.:
ECONOMICS , Nagpur
XI-COM/2025-
NAAC Accredited Autonomous Institution 26/19

(Affiliated to RTM Nagpur University)

(A Hindi Linguistic Minority Institution)
A RUSA Beneficiary Institution
For College use Course Applied For: XI-COM Registration No.
only 3777971
Medium: English

Registration Date: 10/06/2025

University ARN No. :

1. For College / Institute Use Only

Designation Remarks / Particular / Recommendation Signature and Date

Admission Clerk

Admission Officer/ Incharge Member

Accountant / cashier

Category

2nd Language

Transaction Details Payment Mode: OFFLINE Cash Received: 0 Transaction ID.: NA

2. Personal information section

First Name Middle Name Last Name

Name of Student ARYAN ANIL BARASKAR

Father's Name ANIL BARASKAR

Mother's Name: ANITA BARASKAR Marital Status: UNMARRIED

Date of Birth: 04/12/2009 Gender: MALE

Place of Birth: SAWANA Voter ID card No.:

Aadhaar card No.: 829132873700 ABC ID:

Occupation of Father: FARMER Annual Income:

Name of Local Guardian: ANIL BARASKAR

Relationship of Guardian with applicant: SON Mother Tongue: MARATHI

3. Bank Details

Bank Name: Account No.:

Branch Name: CBI IFSC Code: 12345678910

4. Address Details

Address of Correspondence: Sawana,445205, Mahagaon, Yavatmal Pin Code: 445205

State: Maharastra District: YAVATMAL Tehsil: MAHAGAON City: YAVATMAL

Permanent Address: Sawana,445205, Mahagaon, Yavatmal Pin Code: 445205

 State: Maharashtra District: YAVATMAL Tehsil: MAHAGAON City: MAHAGAON

5. Contact Details

Student Mobile No.: 9356233540 Alternate Contact Number:

Student Email Id: [email protected] Parent /Guardian phone: 9356233540

6. Legal Reservation Information Section

Domicile state: Admission Category: OPEN Caste Category: OPEN

Sub Caste: MARATHA Phy. Handicapped:

7. Medium of Instruction in Qualifying Examination : English

8. Do You Belong to Hindi Minority category : Yes / No

9. Category of Registration/ Admission : OPEN/ GENERAL

10. Other Information Section

Would you like to apply for Hostel: NO Employment Status: NO Do you wish to join NCC / NSS: NO

Hobbies, Proficiency and Other interests: NA Games and sports participation:

Do You Have Any Medical History ?: Yes / No If Yes Specify:

Name and Phone Number of the Person to be contacted in case of any Emergency :

11. Education Details Section

Name Examination Passing

Name of of Name of Year of Seat certificate Grade/Total Obt.
Examination Board school/College Passing Number No. Marks Marks % CGPA

SSC CBSE ANNAPURNA 2025 15128045 500 434 86.8 0

Board INTERNATIONAL
SCHOOL OF
SCHOLARS

12. Qualifying Exam Details Section

QUALIFYING EXAM NAME: SSC

Marks
College/School Admission Passing Marks Total Education
Board/university Percentage Place Stream Scored in
Attended Year Year Obt. Marks Gap
English
ANNAPURNA
INTERNATIONAL SCHOOL OF CBSE BOARD 0 2025 434 500 86.8 COMMERCE NO
SCHOLARS
 13. Attached Documents

Sr No. Name of Documents/Certificate

1 HSC MARKSHEET

Undertaking by S.C. /S.T /VJ /N.T. /O.B.C. /S.B.C. /P.T.C. /E.B.C. EWS Concession Holders only:

I hereby declear that I shall attend class regularly and shall complete minimum
attendance of 75% necessary for getting the concession in fees or scholarship as per Government rule. I
know that if do not complete the required attendance in the class, my scholarship or concession form will
be forwarded by the college and I shall be responsible for payment of full fees to the College. In case of
E.B.C./ Scholarship Form is rejected by the Government, I Shall pay full fees College. I also know that in
case I remain absent continuously for one month without permission from the Principal, my name will be
removed from the roll of students.

Place: (i) Signature of the Student:

Date: (ii) Counter Signature of the Parent/Guardian:

Declaration and Undertaking by the Student and Father or Guardian:

I hereby declear that I shall prosecute my studies sincerely, attend classes regularly,
and abide by all the rules and regulations of the College framed from time to time. I shall not take part in
any undesirable activities like ragging, sexual harassment, discrimination against fellow students on basis
of caste, gender, creed, colour, race, religion, language, disability etc., and agitations or any violent
demonstration within premises of the college. I will also submit online anti-ragging undertaking on the
UGC portal. In case I am found guilty of any indiscipline or misbehavior under rules of discipline given in
Prospectus, I know that I shall be allowed in the College/University examinations, if I do not attend 75%
of the lectures delivered in each subject. i also declare that I will strictly abide by all the rules/ regulations
frames by the Government of Maharashtra, RTM Nagpur University and the College for the conduct of
elections for students council of this College and the University.

Place:

Date: (i) Signature of the Student:

I fully agree with the above undertaking signed by my son/ daughter/ ward.

(ii) Counter Signature of the Parent/Guardian:

Warning:

1.Any false statement or information in the application form may lead to student�s expulsion from the
college.
2.Those with short attendance (below 75%) during the semester/session will not be allowed to appear in
the examination. Also their Scholarship / Freeship / Concession forms will not be forwarded to the
concerned department and such students shall have to pay full fees.