For Office Use

Batch: Scrutiny Payment: Online/DD PI

Serial:
Only

PILLAI HOC COLLEGE OF ENGINEERING AND TECHNOLOGY,RASAYANI (822)

Application No :
University of Mumbai 524497
M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
Academic Year: 2024-2025 Regular
APPLICATION FORM

Course Applied for : B.E.(with Credits) - Regular - CBCS - Computer PRN:2023016402429221

Engineering - S.E. C-Scheme Sem III (BECBCS1001)

Application Date : 20/10/2024 Payment Category : 25

1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed PATIL SRUSHTI VARSHANAND
on Mark sheet : [*This name will appear on all University records/documents]
Mother's
Father's/Husband's Name : VARSHANAND MANISHA
Name :
Mother
Marital Status : UnMarried
Tongue :
Place Of Birth : PEN Gender : Female Date of Birth (DD/MM/YYYY) : 01/02/2006
Blood Group : Religion : Country of Citizenship : India
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Raigad Tehsil : Pen City/Town/Village :
Available
Address (House
no,street/area/suburb 156B HAMRAPUR PEN RAIGAD HAMRAPUR Pin Code : 402107
etc.) :
Contact details
Mobile
919822574179 Email ID: srushtipatil1216@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : OBC
Reserved
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
Sem III
CSC301 - Engineering Mathematics-III CSC302 - Discrete Structures and Graph Theory
CSC303 - Data Structure CSC304 - Digital Logic & Computer Architecture
CSC305 - Computer Graphics CSL301 - Data Structure Lab
CSL302 - Digital Logic & Computer Architecture Lab CSL303 - Computer Graphics Lab
CSL304 - Skill Base Lab Course: Object Oriented Programming CSM301 - Mini Project – 1 A
With Java
Sem IV

CSC401 - Engineering Mathematics-IV CSC402 - Analysis of Algorithm

CSC403 - Database Management System CSC404 - Operating System
CSC405 - Microprocessor CSL401 - Analysis of Algorithm Lab
CSL402 - Database Management System Lab CSL403 - Operating System Lab
CSL404 - Microprocessor Lab CSL405 - Skill Base Lab Courses: Python Programming
CSM401 - Mini Project 1-B

Medium of Instruction : English

4.Guardian Information
Occupation of Guardian : Farmer Annual Income of Guardian : 85000
5.Educational Details
Month Exam
Name of Name of Board/University Name of Certificate Mark Out
and Year Seat CGPA %
Examination and State of University School/College No. Obtained of
of Passing No.
MAHARASHTRA STATE
BOARD OF SECONDARY
Std 10th July 2021 -- -- 435.00 500.00 -- - -- 87.00
AND HIGHER SECONDARY
EDUCATION,
MAHARASHTRA STATE
Std 12th 12Th BOARD OF SECONDARY
June 2023 -- -- 387.00 600.00 -- - -- 64.50
(Science) AND HIGHER SECONDARY
EDUCATION,
Your Last Qualifying Exam:
7.Other Information
Would you like to apply for Hostel accommodation required NA
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 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 )
Document printed on Sun Oct 20 2024 14:23:48 GMT+0530 (India Standard Time)