Admission Form ( 2018-19)
GOVERNMENT POLYTECHNIC, AHMEDNAGAR .
Email address *
Name of Student Fill in Capital letters only (as per 10th / SSC Markshit) *
Paste here Passport Size Photo
Enrollment Number *
Academic Year *
Parent/Guaradian Full Name Fill in Capital Letters Only (If Father is Dead then Fill Guaradian Name) *
Relation with Parent/Guaradian *
Mother Name (Fill in Capital Letters For eg Fill Only NALINEE ) *
Nationality *
Aadhar Number *
Bank Name (Fill in Capital Letters Only) *
Bank Branch Name (Fill in Capital letters Only) *
Bank Account Number *
IFSC Code *
MICR Code *
Admission Type *
Course Year *
Branch Name *
Mobile Number (Self) *
Mobile Number (Parent / Guardan) *
DOB (as per 10th/SSC leaving certificate) *
MM
/
DD
/
YYYY
DOB (in words Fill in Capital letters Only) *
Age Of Student (in Figures Only) *
Permenent Adress (Fill in Capital letters Only) *
Admission in TFWS ( Seat Type) *
Place of Birth (as per 10th/SSC Leaving Certificate Fill in Capital letters Only) *
Religion (as per 10th/SSC Leaving Certificate) *
Caste (as per 10th/SSC leaving certificate Fill in Capital letters Only for eg:- HINDU-MARATHA) *
Category *
Facility taken *
Have you change branch in second year? (For Third Year Student Only) *
If yes, which branch taken
Name of Last school/College Attended (10th/12th/ITI) before Admitting GPAN (Fill in Capital letters Only) *
Gender *
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 ) *
Date of Admission (For First Year/Direct Second Year as per Admission Fee Receipt) *
MM
/
DD
/
YYYY
Tution Fee Paid ( As per facility taken) *
Other Fee Paid (For FY & DSD Rs. 1750 and Regular SY/TY Rs. 1550) *
Exam Fee Paid (For Carry On Choose 0 Only) *
OTO Fee (For Carry On Student Only)
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 *
Have you want Admission in Boy's/Girl's Hostel of Govt. Polytechnic, Ahmednagar *
Documents attached with this form (Xerox Copy) *
Required
Signatures *
Required
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