BSM: Deo-Ghaisas-Keer Arts Commerce Science Senior College

Pre-Admission Form

Instructions:

1. Please insure the form is complete in all aspects.

2. Incomple/Illegible form will not be considered valid.

3. Field marked with * are required.

PERSONAL INFORMATION: (Required)

*NAME OF THE STUDENT:

*NAME OF THE FATHER/HUSBAND:

*NAME OF THE MOTHER:

*DATE OF BIRTH: ddmmyyyy

*Age: yrs

*PLACE OF BIRTH:

*Gender:

PRESENT ADDRESS: (Required)

*ADDRESS LINE NO.1:
*ADDRESS LINE NO.2:
*PIN CODE:	Enter 6 digit valid pin code

PERMANENT ADDRESS: (Required) Same as present address (Once checked you can't edit present/permanent address, Uncheck to edit.)

*ADDRESS LINE NO.1:
*ADDRESS LINE NO.2:
*PIN CODE:	Enter 6 digit valid pin code

CONTACT DETAILS: (Required)

*MOBILE NUMBER:

+91

*EMAIL ADDRESS:

EDUCATIONAL QUALIFICATION: (Required)

*EXAM	*NAME OF INSTITUTION	*BOARD/UNIVERSITY	*YEAR OF PASSING	*PERCNTAGE	*GRADE/CLASS

Declaration

* I hereby declare that all the entries are correct to the best of my knowledge and belief. I also understand that in case it is detected at any stage of that I do not fulfill the eligibility norms and/or that the information furnished by us is incorrect/false or that we have suppressed any material fact(s), the candidature of the applicant will stand cancelled.

BHARAT SHIKSHAN MANDAL'S

DEO-GHAISAS-KEER ARTS COMMERCE SCIENCE SENIOR COLLEGE, RATNAGIRI

Guruvarya Achyutrao Patwardhan Marg, Maruti Ali, Near Athavada Bazaar,

Ratnagiri - 415612, Maharashtra, India

Email: bsm2016rtn@gmail.com

Tel: +91 2352 225186

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