8/14/2019 Kamal.pdf
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Hostel Information
Name of Landlord /Hostel
Hostel AdmissionDate
Hostel Type Is Mess Service Available? No Rent Per Month
0.00
Hostel/ LandlordAddress
Hostel/LandlordContact Details
Is Studying in night school No
Document Details
Caste Certificate No 1284 District IssuingOffice
Thane Taluka IssuingOffice
Bhiwandi
Caste ValidityCertificate No
359 District IssuingOffice
Thane ScrutinyCommittee No
N.A
Income CertificateNo
MAG/SR/7314 Issued in 2013UniversityRegistration No
N.A
Student Bank Account Details
Bank Name STATE BANK OF INDIA BankAccount No
31091904623
Branch Name WADALA, MUMBAI
IFSC Code SBIN0001102 MICR Code 400002085
Caste Certificate Issued by Competant OfficerIncome Proof Income
Certificate Issued by Competant AuthorityMarksheetsI-card Size
PhotoCaste Validity Certificate
SSC Mark SheetUID document xerox
Document Attached
Address For Correspondence
Address:- PANCHASHILA NAGAR Location:- BARKAT ALI DARGA City:-
WADALA Pincode:- 400037 Taluka:-Mumbai District:- Mumbai
Parent / Guardian Details
Parent's name SHERALI MIRJA KHAN
Relation with Applicant Mother
Age (yrs)
Profession Service
Parmanent Address PANCHASHILA NAGAR Location:- BARKAT ALI DARGA
City:- WADALA Pincode:- 400037Taluka:- Mumbai District:- Mumbai
Annual Income 55000.00Is Father Alive Yes
Declaration
The information furnished by me is complete and correct. I bear
the complete responsibility for all the aboveinformation.
Applicant's Signature Applicant Parent's Signature
Principal's Signature
_______________________ _______________________
_______________________
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