Exam Fees Receipt No.

VIVEKANAND EDUCATION SOCIETY’S INSTITUTE OF TECHNOLOGY

(An Autonomous Institute Affiliated to University of Mumbai, Approved by AICTE & Recognized by Govt. of Maharashtra)
(On Behalf of University of Mumbai / University of Mumbai)

Admission Type Exam Session Year Semester

1 = Provisional 1 = First Half 2222 (C-2019)
0 = Non- Provisional 2 = Second Half

2019016402315033
Branch Name: -
CMPN PRN ________________________

1.NAME Surname
B a j a j Photograph
First/ Own Name
Tanya Do not pin/Staple
Father’s/Husband’s
Name Premchand Paste inside the
box only
Mother’s Name
Jyoti Not to be attested
2. The above name in DEVANAGARI SCRIPT (in Marathi)

3. COMPLETE POSTAL ADDRESS 4. Gender 5. EBC/Non- EBC

____________________________________________
Matrukripa , near Meet n Melt , Navjeevan colony 1. Male 1. EBC
Shankar nagar , farshi stop , Amravati
____________________________________________ 2. Female 2 2. Non-EBC 2
___________________________________________
PIN__________
444605 Tel No. /Mob. ________________
8080711643 6. Category 7. Student Type
0 = Open 4. = NT 1 1. = Student
1 = SC 5. = NT 2 0 2. = Ex-Student
2 = ST 6. = NT 3
3 = DT 7. = OBC/SBC

8. Subject Offered (Please fill the subject to be appeared) 9. Year in which kept terms for Sem ______
Paper Marks Obtained From July 20 ______ To Nov. 20______
No. Subject Name Int. Theory Term Oral Practical PR &
Ass. Work OR
From Jan. 20 ______ To April 20 _____
1. 10. Details of Lower Examination
2. semester Month & Year Seat No. of
Passing No. Heads in
which the
3. student
has failed

4. I

5. II

6. III

7. IV

8. V

9. VI
VII
To,
Controller of Examination, Certificate from the Class Teacher
VES Institute of Technology, I certify that student has kept terms for the examination as per University rules
H.A.M.C. Collector’s Colony, R.C. Marg, Chembur-74. satisfactorily and he/ she is eligible to appear at the examination. I also certify that
Madam, the information furnished is the candidate in the examination form is correct.
I request permission to present myself for ensuring
examination. I have remitted the prescribed fee for the
Same accordingly and the information furnished above Place: - ________________
is correct.
Place: ___________ Date: - _________________ Signature

Date:-__________ Candidate’s Signature

Examination Fees for 1 head of failure Rs. 304/-, for 2 heads of failures Rs. 546/-,
For 3 or more heads of failures & Fresh Students Rs. 1154/-,
Fees for Statement of Marks Rs. 50/-, Cost of Form Rs. 10/-, w.e.f. First half 2018, vide circular No .Exam/Fees/15/2018 date 31/01/2018.