Fees (शु क): 585 Payment By (शु क भरणा पयाय)

E
Provisional (अ थायी): 1 Online Payment

Institute of Distance and Open Learning, University of Mumb

Dr. Shankar Dayal Sharma Bhavan, Vidyanagari, Kalina, Santacruz East, Mumbai -
Maharashtra(India)

Application Form for Examination of October 2019

Program (अ यास म) : BA-Repeater Pattern-FY BA-F.Y.B.A (1)

Application Date (अजाची तार ख) : 16/09/2019

1.Personal Information (वैयि तक मा हती)

Last Name First Name ( वतःचे Father’s/

(आडनाव): नाव): (व डलांचे/ प

Candidate's Name ( व या याचे नाव) : RAMBHIYA DISHA RAMNIK

Mother’s Name (आईचे नाव) : RASHMI

Name change is not allowed in exam form. Name as printed on last year mark-sheet will be allowed in e

RAMBHIYA DISHA
व या याचे संपण
ू नाव: RAMNIK RASHMI
Mother Tongue
Marital Status (वैवा हक ि थती): UnMarried Gujarati
(मातभ
ृ ाषा):

Place of Birth (ज माचे ठकाण): Mumbai Gender ( लंग): Female Date of Birth (ज म तार ख)

Blood Group (र तगट): Religion (धम):Hindu

Address for Correspondance (संपकासाठ प ता)

City/Tow
State (रा य): Maharashtra District (िज हा): Thane Tahsil (तालक
ु ा): Kalyan
गाव/ खेड)े
Address (House C-412, Madhavashram Nagar No.2, Sangeeta Shiv Mandir Road
no,street/area/suburb etc.) /
प ता(घर ./ े / उपनगर इ.):

Contact details (संपकाचे तपशील)

Mobile Number
9892223447 E-mai
( मण वनी)

Legal Reservation Information (कायदे शीर आर ण मा हती)

Category Type (जातीचा कार): Open Category (जातीचा वग) : GEN Subcategory (उ

Is Specially Abled? ( द यांग)No

Social Information (Additional Info) (सामािजक मा हती)

Exam Details (पर ेचा तपशील): Exam Center Preference 1: T

Admission taken in the year ( वेश घेतलेले वष)

Admission taken for in the year: NA PRN No./ Roll No (Op

To be filled in by Repeaters (पव

ू पर ेस अज केलेले व याथ )

Last attended examination status: Passed Last Sea

Last attended examination Month and Year (mm/yyyy): February 2010
Regular Pattern/ Semester Pattern
Whether appeared First Year in Regular Pattern or Semester Pattern : Regular
Have applied for Class Improvement? : No
Course List for : F.Y.B.A
Answer
Group Name Course (Subject) Name
Language
Communication Skills in
Compulsory Group English Theory
English(00)
Language Group French(14) English Theory
Foundation Course -
Compulsory Group English Theory
Paper – I(21)
Optional Group Philosophy – Paper I(42) English Theory
Optional Group Psychology -Paper - I(43) English Theory
Optional Group Education – Paper –I(64) English Theory
/
First Year First Attempt Mark Sheet
IDOL Identity card/ IDOL Admission Form/IDOL Fee Receipt

Educational Details (शै णक मा हती)

Month and Year Exam Seat Ma

Name of Name of Board/University Name of of Passing No. (पर ा Obtai
Examination and State of University School/College
(उ तीण के याचा आसन ( ा
(पर ेचे नाव) (बोड/ व यापीठ/ रा य) (कॉलेजचे नाव)
दनांक) मांक) गण
ु

First
University of
Year/Part I IDOL September 2018 1512 214.00
Mumbai,Maharashtra
BA

Declaration by the Student ( व या याने दलेल हमी)

मी येथे घो षत करतो/ करते क , मा हती प क/ संकेत थळावर दले या मा हतीनस
ु ार मी पर े या अजाचे
मा हती/ द तऐवज मा या सव तम आकलनानस
ु ार स य आ ण पण
ू आहे त. कोण याह ट यावर ह मा ह
पर ेचा अज र होईल. काय यानस ु ार मा यावर खटला भरला जाईल. माझा वेश र होईल आ ण सं था यास
I hereby declare that, I have read the rules related to examination as given in the prospectus/ website an
are true and complete to the best of my knowledge. If the information/ Documents are found to be
cancelled & I am liable to be prosecuted & Institute will not be responsible for the same.

Place ( थान): Date (तार ख): ( Sign

Document printed on Wed Nov 06 2019 18:35:14 GMT+0530 (India Standard Time)