Late B. P. Patil Jr. College Of Science

Pimpalgaon Baswant, Maharashtra 422209

Enquiry Form

Name Of The Candidate:

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Date Of Birth:(DD-MM-YYYY)

Gender:

Nationality:

State Of Domicile:

Category:

Adhar No:

Father's Name:

Occupation:

Moblie No:

Mother's Name:

Occupation:

Moblie No:

Course Applied for:(IIT-JEE, NEET and MHT-CET)

Do you required hostel accommodation:

Academic Qualification:

Examination	Name of School	Medium	Year	Marks in % or Grade

Address for Correspondence:

Phone/Mobile No:

Email:

Scholarships/Distinctions/Awards received:

Extra-curricular activities,hobbies:

Declaration By The Student

I hereby declare that the above entries in the form are true to the best of my knowledge and belief. I also declare that no criminal proceedings are/were against me in any court of law or any other authority of the country. Further, I hereby undertake to abide by the rules and regulations of the college/hostel/mess, as may be laid down from time to time. In case of any wrong declaration, my admission may be canceled, and I will have no objection to the same.

Date:

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