(1) Application Number: 051520130101000018 Bar Code:
*051520130101000018*
(2) Applicant Details:
2.1 Name: DABHADE PUNNIKA PURUSHOTTAM 2.3 Birth Date: 29/08/1996 2.4 Email Address: punnikadabhade@gmail.com 2.5 Mobile No: 9890403572
2.2 Gender: Female
2.6 Address of Correspondence: 2.7 Date of Application Confirmation:
BHIMNAGAR BHAUSING PURA, AURANGABAD, Taluka : Aurangabad, District : Aurangabad, State : Maharashtra, Pin Code : 431001 07/08/2013 10
2.8 Permanent Registration Number allotted by the College:
(3) Applicant’s Caste Certificate Details:
3.1 Caste Category: 3.2 Caste: Scheduled Caste Mahar (37) 3.3 Sub caste: N.A
3.4 Caste Certificate Number: 2012/SC/CR-3627 3.5 Caste Certificate Issued by: 3.6 District: Aurangabad SUB DIVISIONAL OFFICER
(4) Applicant’s College Details:
4.1 Name of College: 4.2 Address of College: C. K. Goyal Junior College Khadki, Khadki,Pune, Taluka : Haveli, District : Pune, State : Maharashtra, Pin Code : 411003 1982 12th Science 4.5 Division: A 4.6 Roll No: 10
4.3 College Registration Number: 4.4 Studying in (11th or 12th Science):
(5) Scrutiny Committee Details (To which the concerned college will submit the application.)
5.1 Name of Committee: 5.2 Address of Committee: Aurangabad Division Committee No.1, Aurangabad Plot No. 10, Near St. Lawrance School, Town Centre, CIDCO, Aurangabad, Taluka : Aurangabad, District : Aurangabad, State : Maharashtra, Pin Code : 431001 Year of document N.A N.A N.A N.A N.A N.A Caste mentioned in the document N.A N.A N.A N.A N.A N.A
(6) Document Details (Documents attached by the applicant)
Document Description Original Caste Certificate of the Applicant Certified Copy of Caste Certificate of the Applicant Original Affidavit (In Specimen Form 3 Rule - 4(1)) Original