For Office Use Only:

1) MH-CET Merit No.

2) MH-CET Total Marks

3) Graduation Total Marks/Out of

4) Graduation Degree

5) Category

6) Prepared By

Checked By

All the information is to be filled by the applicant-in BLOCK LETTERS only

1) Name as in Graduation

2) MH-CET/AIEEE/CET Merit No.

3) MH-CET/AIEEE/CET Total Marks out off

4) Education Qualification

5) Whether you Passed Graduation in First Attempt

Yes/No

6) Admission Under

Govt.(CAP)/AIEEE (CAP) / Management / Other Quota.

[Tick whichever is applicable]

7) Category

(Whether OPEN/SC/VJ/NT1/NT2/NT3/OBC/SBC)

8) Religion/Caste

9) Date of Birth

10) Sex

11) Father's/Guardian's Name

12) Correspondence Address with Phone No.

13) Permanent Address with Phone No.

14) Parent/Guardian/Student/ E-mail

15) Declaration by the Candidate's Parent/Guardian

I do hereby declare that-
  i) The particulars furnished by my son/ward in the application form are correct to the best of my knowledge.
  ii) I undertake & bind myself to pay on behalf of my son/ward such fees, charges etc. which the College my levy from time to time by the due date and in the event of failure on my part and / or on the part of my son / ward, the principal of the College my take such action against my son / ward as the my deem fit.