GROUP OF INSTITUTIONS

PROVISIONAL ADMISSION FORM (MCA I YR./ MCA Direct II YR.)

(TGPCET)

(TGPCET)

PROVISIONAL ADM. No.Name of Staff:

Name of Candidate:______________________________________________________________________________________ _____________

Father's Name:_______________________________________________ Mother's Name:__________________________________________

Category:___________Caste:__________________ Date of Birth: ________________ Place of Birth: _________________ (Dist:___________)

Communication Addres: At _______________________ Post _______________________ Tah. ___________________ Dist. _______________

Pin Code: ______________________ Father's Occupation: _____________________________ Annual Income: _________________________

th th10 Roll No: ____________________________ 12 Roll No.: _______________________

Mobile Number: (1) ________________________________________________ (2) ________________________________________________

Name & Address of Grad.College: __________________________________________________________Area: _________________________

th thAggr. Percentage in 10 % 12 % Gradu.% Marks Out of

Year of Passing: ( Last Exam.: ____________________________________ Stream: _______________________________________________)

MCA-CET APP.ID.: ___________________________ MCA-CET Roll No.: ____________________ MCA-CET Score:_______________

TF (C) Scholarship Hostel Fees Bus Fees Mess Fees L.M. Remarks

List of Original Documents submitted (Tick Mark on the right)

1 10th Marksheet/Diploma 2 12th Marksheet/Diploma 3 Leaving Certificate (TC)

4 Caste Certificate 5 Caste Validity 6 Non creamy layer Certificate

7 Age / Domicile / Nationality 8 Score Card-MH-CET 9 Proforma - H

10 Bank Pass Book Xerox 11 Gradu. MS ( I , II, III, IV, V, VI Sem.) 12 Income Certificate

13 Adhar Card Xerox

DECLARATION BY STUDENTI hereby declare that with the consent of my parents/guardian,I have willingly taken provisional admission to course offered by Gaikwad-Patil Group of Institutions. I am submitting my original documents to them without any pressure. I have read the instructions of provisional admission and also cancellation of admission. For cancellation of my provisional admission, I will strictly follow the rules of the institute known prior to me. i.e. I) Either i am not eligible II) By paying Rs. 5000/- cancellation charges III) After CAP rounds. Further I state that i will not launch any complaint to any higher authority for issue of admission. If I do so it will be consider as invalid.

Fees Paid: ___________________ Receipt No: _______________ Date: __________

Signature of the Candidate/ Parent Date:_______________ Signature & Name of the Faculty/Counseller

Acknowledgment Slip GAIKWAD-PATIL GROUP OF INSTITUTIONS Date: ______________

Full Name of the student : _____________________________________________________________________________________________

List of Original Documents submitted (Tick Mark on the right)

1 10th Marksheet/Diploma 2 12th Marksheet/Diploma 3 Leaving Certificate (TC)

4 Caste Certificate 5 Caste Validity 6 Non creamy layer Certificate

7 Age / Domicile / Nationality 8 Score Card-MH-CET 9 Proforma - H

10 Bank Pass Book Xerox 11 Gradu. MS ( I , II, III, IV, V, VI Sem.) 12 Income Certificate

13 Adhar Card Xerox

DECLARATION BY STUDENT

I hereby declare that with the consent of my parents/guardian,I have willingly taken provisional admission to course offered by Gaikwad-Patil Group of Institutions. I am submitting my original documents to them without any pressure. I have read the instructions of provisional admission and also cancellation of admission. For cancellation of my provisional admission, I will strictly follow the rules of the institute known prior to me. i.e. I) Either i am not eligible II) By paying Rs. 5000/- cancellation charges III) After CAP rounds. Further I state that i will not launch any complaint to any higher authority for issue of admission. If I do so it will be consider as invalid.

Signature & Name of the Faculty

{ Contact No.:-________________________} Signature & Name of the Candidate/ Parent

Passport size photo

Signature of studentThumb impression of student

(Right Thumb)Thumb impression of student

(Left Thumb)