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6/10/2017
..:: State Common Entrance Test Cell, Government of Maharashtra ::..
First Year Degree in Engineering/Technology issions 2017
Application Form
STATE COMMON ENTRANCE TEST CELL 305, Government Polytechnic Building, 49, Kherwadi, Bandra (E), Mumbai – 400 051 (M.S.) Application Form for ission to First Year of Under Graduate Technical Courses in Engineering and Technology for the Academic Year 201718
Application ID : EN17213130 Version No : 1 Personal Details Candidate's Name MUKUL SURESH SHENDE Father's Name SURESH Mother's Name MAMTA Gender Male Date of Birth 23/01/2000 Candidature Type Maharashtra Type A Home University Rashtrasant Tukadoji Maharaj Nagpur University Category SC Category for ission SC Person with Disability Not Applicable Defence Type Not Applicable Applied for TFWS Seats No Minority Candidature Type No District from which Candidate has ed SSC Nagpur District from which Candidate has ed HSC / Diploma / B.Sc. Nagpur Application Fee Paid (Rs . ) 600/
Nationality India
I, the holder of Aadhaar Number [326624206230], hereby give my consent to State CET Cell to obtain my Aadhaar number for authentication with UIDAI. State CET Cell has informed me that my identity information Aadhaar Number would only be used for ission purpose and will be submitted to CIDR only for the purpose of authentication. Has Bank ? Yes Number 7808001500002937
IFSC Code PUNB0780800
Qualification Details Qualification
Marks Obtained
Marks OutOf
Percentage
SSC Mathematics Marks
89.00
100.00
89.00
SSC Science Marks
75.00
100.00
75.00
SSC English Marks
88.00
100.00
88.00
418.00
500.00
83.60
HSC Physics Marks
59.00
100.00
59.00
HSC Mathematics Marks
61.00
100.00
61.00
HSC Chemistry Marks
45.00
100.00
45.00
HSC Biology Marks
53.00
100.00
53.00
HSC English Marks
71.00
100.00
71.00
411.00
650.00
63.23
SSC Aggregate Marks
HSC Aggregate Marks
SSC Board Maharashtra State Board of Secondary and Higher Secondary Education, Pune SSC ing Year 2015
SSC Seat Number J128317
Qualifying Exam HSC
HSC ing Status ed
HSC Board Maharashtra State Board of Secondary and Higher Secondary Education, Pune HSC ing Year 2017
HSC Seat Number N045507
MHTCET 2017 Details Appeared for CET Yes
Roll No MM4242406
Physics Score 17
Chemistry Score 21
Mathematics Score 34
Total Score 72
JEE (Main) 2017 Paper1 Details Appeared for JEE Yes
Roll No 15703789
Physics Score 16
Chemistry Score 0
Mathematics Score 9
Total Score 25
List of Documents Required at the time of Document Verification and Confirmation at Facilitation Center (Do not attach Xerox Copies) Sr. No. 1. 2. 3. 4. 5. 6. 7. 8.
Document Name Certificate of Indian Nationality in the Name of the Candidate. School Leaving Certificate of the Candidate showing his / her Place of Birth in the State of Maharashtra. Caste Certificate clearly mentioning the Category of the Candidate and also the remarks that the caste is recognised as backward class in the State of Maharashtra. Caste / Tribe Validity Certificate in the Name of the Candidate, issued by the Caste / Tribe Validity Committee of Maharashtra State. Statement of Marks or Certificate of ing SSC / Equivalent Examination. Statement of Marks or Certificate of ing HSC / Equivalent Examination. Score Card of JEE Main (Paper 1) 2017. Cancelled Cheque of Bank / 1st Page of Book.
Declaration I have read all the rules of ission and on understanding these Rules, I have filled this Application Form for ission to First Year of Under Graduate Technical Courses in Engineering and Technology for the Academic Year 201718. The information given by me in this application is true to the best of my knowledge & belief. If at later stage, it is found that I have furnished wrong information and/or submitted
https://fe2017.dtemaharashtra.gov.in/CandidateModule/frmPrintApplicationForm.aspx
1/2
6/10/2017
..:: State Common Entrance Test Cell, Government of Maharashtra ::..
false certificate(s), I am aware that my ission stands cancelled and fees paid by me will be forfeited. Further I will be subject to legal and/or penal action as per the provisions of the law. Place : Date : 10/06/2017 Printed On : 10/06/2017 8:10:18 PM Last Modified On : 10/06/2017 8:06:05 PM Last Modified By : EN17213130, 49.35.5.78
https://fe2017.dtemaharashtra.gov.in/CandidateModule/frmPrintApplicationForm.aspx
Signature of Applicant (MUKUL SURESH SHENDE)
2/2
..:: State Common Entrance Test Cell, Government of Maharashtra ::..
First Year Degree in Engineering/Technology issions 2017
Application Form
STATE COMMON ENTRANCE TEST CELL 305, Government Polytechnic Building, 49, Kherwadi, Bandra (E), Mumbai – 400 051 (M.S.) Application Form for ission to First Year of Under Graduate Technical Courses in Engineering and Technology for the Academic Year 201718
Application ID : EN17213130 Version No : 1 Personal Details Candidate's Name MUKUL SURESH SHENDE Father's Name SURESH Mother's Name MAMTA Gender Male Date of Birth 23/01/2000 Candidature Type Maharashtra Type A Home University Rashtrasant Tukadoji Maharaj Nagpur University Category SC Category for ission SC Person with Disability Not Applicable Defence Type Not Applicable Applied for TFWS Seats No Minority Candidature Type No District from which Candidate has ed SSC Nagpur District from which Candidate has ed HSC / Diploma / B.Sc. Nagpur Application Fee Paid (Rs . ) 600/
Nationality India
I, the holder of Aadhaar Number [326624206230], hereby give my consent to State CET Cell to obtain my Aadhaar number for authentication with UIDAI. State CET Cell has informed me that my identity information Aadhaar Number would only be used for ission purpose and will be submitted to CIDR only for the purpose of authentication. Has Bank ? Yes Number 7808001500002937
IFSC Code PUNB0780800
Qualification Details Qualification
Marks Obtained
Marks OutOf
Percentage
SSC Mathematics Marks
89.00
100.00
89.00
SSC Science Marks
75.00
100.00
75.00
SSC English Marks
88.00
100.00
88.00
418.00
500.00
83.60
HSC Physics Marks
59.00
100.00
59.00
HSC Mathematics Marks
61.00
100.00
61.00
HSC Chemistry Marks
45.00
100.00
45.00
HSC Biology Marks
53.00
100.00
53.00
HSC English Marks
71.00
100.00
71.00
411.00
650.00
63.23
SSC Aggregate Marks
HSC Aggregate Marks
SSC Board Maharashtra State Board of Secondary and Higher Secondary Education, Pune SSC ing Year 2015
SSC Seat Number J128317
Qualifying Exam HSC
HSC ing Status ed
HSC Board Maharashtra State Board of Secondary and Higher Secondary Education, Pune HSC ing Year 2017
HSC Seat Number N045507
MHTCET 2017 Details Appeared for CET Yes
Roll No MM4242406
Physics Score 17
Chemistry Score 21
Mathematics Score 34
Total Score 72
JEE (Main) 2017 Paper1 Details Appeared for JEE Yes
Roll No 15703789
Physics Score 16
Chemistry Score 0
Mathematics Score 9
Total Score 25
List of Documents Required at the time of Document Verification and Confirmation at Facilitation Center (Do not attach Xerox Copies) Sr. No. 1. 2. 3. 4. 5. 6. 7. 8.
Document Name Certificate of Indian Nationality in the Name of the Candidate. School Leaving Certificate of the Candidate showing his / her Place of Birth in the State of Maharashtra. Caste Certificate clearly mentioning the Category of the Candidate and also the remarks that the caste is recognised as backward class in the State of Maharashtra. Caste / Tribe Validity Certificate in the Name of the Candidate, issued by the Caste / Tribe Validity Committee of Maharashtra State. Statement of Marks or Certificate of ing SSC / Equivalent Examination. Statement of Marks or Certificate of ing HSC / Equivalent Examination. Score Card of JEE Main (Paper 1) 2017. Cancelled Cheque of Bank / 1st Page of Book.
Declaration I have read all the rules of ission and on understanding these Rules, I have filled this Application Form for ission to First Year of Under Graduate Technical Courses in Engineering and Technology for the Academic Year 201718. The information given by me in this application is true to the best of my knowledge & belief. If at later stage, it is found that I have furnished wrong information and/or submitted
https://fe2017.dtemaharashtra.gov.in/CandidateModule/frmPrintApplicationForm.aspx
1/2
6/10/2017
..:: State Common Entrance Test Cell, Government of Maharashtra ::..
false certificate(s), I am aware that my ission stands cancelled and fees paid by me will be forfeited. Further I will be subject to legal and/or penal action as per the provisions of the law. Place : Date : 10/06/2017 Printed On : 10/06/2017 8:10:18 PM Last Modified On : 10/06/2017 8:06:05 PM Last Modified By : EN17213130, 49.35.5.78
https://fe2017.dtemaharashtra.gov.in/CandidateModule/frmPrintApplicationForm.aspx
Signature of Applicant (MUKUL SURESH SHENDE)
2/2
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