Attached
Photo Here
SHIVAJI UNIVERSITY, KOLHAPUR
Student Registration Form
1) Course :
2) Academic Year
3) Course Part :
4) Pattern : Semester/Yearly
5) College/Department :
6)Branch :
7) Course Duration : ____________ Year
8)Student Name (Starting With Surname)______________________________________________________
9) Mother Name : ______________________
10) Date Of Birth : _________________
11) Marital Status : ______________________ 12)Gender: M/F/Other
14) Religion : _______________
15) Cast : ______________
17) Reservation Category : Reserved/ Open
19) Nationality : ______________
13) Blood Group ____________
16) Sub Cast : ___________
18) Student Category: (Student from List ‘B’ )___________
20) Pass Port No : ___________ 21) Driving Lincence No _______
22) Annual Family Income : _________________ 23) Minority : Jain/Muslim/Shikh/Parshi/Budh/Christian
24) Organ Donor : Yes/No
25) Rural/Urban_________________
26) Election Voting Card No : _____________________________________
27) Adhar Card No : ____________________________________________
28) Bank Details : 1) Bank Name : _________________________________
2) Branch : _____________________________________
3) MICR Code : _________________________________
4) IFSC Code : __________________________________
29) Correspondence Address :
State : ______________ __District :________________ Tehsil: ______________ City :______________
Address :______________________________________________________________________________
Pin Code : __________________
30) Permenent Address :
State : ______________ District :________________
Tehsil: ______________ City :____________
Address:________________________________________________________ Pin Code : ___________
Mobile Number :_____________________Email ID : _____________________________________________
Phone Number : -___________________Alternate Email ID :______________________________________
31) Parent/Guardian Name :
Occupation : (Choose From list ‘C’)____________________ Phone Number : ______________________
32) Learning Mode : Regular/Distance
Migration : Yes/No Student Activity : NSS/NCC/Cultural Events/Sports
P.T.O.
33) Physical Disability : Choose from following is applicable
1. Visually Impaired
2. Hearing Impaired
3. Orthopedic Disorder
4. Mentally Retired
5.Speech/Hearing
6. Other Disabilities
34) Previous Exam Details :
Sr.
No.
1.
Exam Name
Board/University Name
Exam Year
Exam
Month
Seat
No.
Percentage
2.
3.
35) Attached Document and Certificates :
1.______________________________ 2. __________________________ 3 ______________________
4___________________________ 5_________________________ ______ 6______________________
36) Social Reservation Information : (Select from the List ‘A’) _________________
37) Subject Details :
Sr
Compulsory Subject
No.
Th
Pr
Internal
Y/N
Y/N
Y/N
Optional Subject
1.
2.
3.
4.
5.
6.
Your's Sincerly,
Signature
1
2
3
4
5
6
7
8
9
10
11
12
A) Social Reservation
Ex-Serviceman/ Ward of Ex-serviceman
Active-Serviceman/Ward of Active-Serviceman
Freedom Fighter/Wars of Freedom Fighter
Ward of Primary Teacher
Ward of Secondary Teacher
Not Applicable
Deserted/Divorced/Widowed Woman
Member of Project Affected Family
Member of Earthquake Affected Family
Member of Flood/Famine Affected Family
Resident of Tribal Area
Kashmir Migrant
B) Reservation Category
Other Backward Class
SBC
N.T. (D)
N.T. (B)
N.T. (C)
Scheduled Cast
Scheduled Tribe
V.J. (A)
C) Guardian Occupation
Farmer
Service
Business
Labour
Pensioner
Consultant