Admission Form ( 2019-20)
Email address *
Name of Student Fill in CAPITAL letters only (As per 10th / SSC Marksheet) *
Paste here Passport Size Photo
Mobile No. (Self) *
Academic Year *
Enrollment No. *
Aadhar No. *
Mother Name (Fill in CAPITAL Letters For eg Fill Only NALINEE ) *
Gender *
Caste (As per 10th/SSC leaving certificate Fill in CAPITAL Letters Only for eg:- HINDU-MARATHA) *
Nationality (Tick Only if it is mentioned on previous Leaving Certificate) *
DOB (As per 10th/SSC leaving certificate) *
DOB (In words) *
Place of Birth (As per 10th/SSC Leaving Certificate) *
Name of Last school/College Attended (10th/12th/ITI) before Admitting GPAN *
Date of Admission (For First Year/Direct Second Year as per Admission Fee Receipt) *
Parent/Guaradian Full Name Fill in CAPITAL Letters Only (If Father is Dead then Fill Guaradian Name) *
Relation with Parent/Guaradian *
Bank Name (Fill in CAPITAL Letters Only) *
Bank Branch Name (Fill in CAPITAL Letters Only) *
Bank Account No. *
IFSC Code *
MICR Code *
Admission Type *
Current Course Year *
Branch Name *
Mobile No. (Parent / Guardan) *
Age Of Student *
Permenent Adress (Fill in CAPITAL Letters Only) *
Admission in TFWS ( Seat Type) *
Religion (As per 10th/SSC Leaving Certificate) *
Category *
Facility taken *
Have You Apply MahaDBT Scholarship Form In Previous Year? *
If Yes, Mention here MahaDBT Scholarship ID
Have you change branch in second year? (For Third Year Student Only) *
If yes, which branch get in First Year Admission?
Blood Group *
Previous class Attended *
Previous class Result *
Previous class Total Marks (Aggregate) *
Previous class Obtain Marks (Aggregate) *
Previous class Percentage (Aggregate) *
Have you any physical Disability? *
If yes, which type of Disability
Parent/Guardian Annual Income (As per previous year Income Certificate Annual Year 2018-19 ) *
Tution Fee Paid ( As per facility taken For OPEN/Paying Rs. 6000/-, For EBC, OBC, SEBC, EWS & Ex-Servicemen Rs. 3000/-, For Category (SC, SBC, VJNT & ST) /Handicape/PTW/STW/TFWS Rs. 0/-) *
Other Fee Paid (For FY & DSD Rs. 1750 and Regular SY/TY Rs. 1550) *
Exam Fee Paid *
Enrollment Fee ( For First Year & Direct Second Year only)
Eligibility Fee ( For Direct Second Year only)
Insurance Fee (For First Year - Rs. 454 , Direct Second Year - Rs. 234)
Total Fee Paid (For OPEN/Paying Rs. 8750/-, EBC, OBC, SEBC , EWS & Ex-Servicemen Rs.5750/-, Category (SC, SBC, VJNT & ST) /Handicape/PTW/STW/TFWS/Rs. 2750/-) *
First Instalment of Scholarship Amount Paid in Previous Year? *
If Yes, How much First Instalment of Scholarship Amount Paid? (Fill in Figures Only)
Fill here Pink Coloured First Instalment of Scholarship Fee Paid Receipt No.
Have you want Admission in Boy's/Girl's Hostel of Govt. Polytechnic, Ahmednagar *
Documents Attached with this form (Xerox Copy) *
Signatures *
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