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First Year Degree in Engineering/Technology Admissions 2022-23 Application Form

GOVERNMENTOFMAHARASHTRA
STATECOMMONENTRANCETEST CELL,MAHARASHTRASTATE ARA
8th Floor, New Excelsior Building, A.K.Nayak Marg, Fort, Mumbai-400001. (M.S.)

Application Form for Admission to First Year Under Graduate Technical Courses in
Engineering and Technology (4 Years) & Master of Engineering and Technology (Integrated 5
Years) Admissions A.Y. 2022-23
Application ID : EN22198861 Version No : 2
Personal Details
Candidate's Full Name DWIVEDI ANKUSH AJAY
Father's Name AJAY DWIVEDI
Mother's Name SARITA DWIVEDI
Gender Male
Date of Birth 02/03/2004
Candidature Type Maharashtra - Type A
Home University Rashtrasant Tukadoji Maharaj Nagpur University
Category Open
Category for Admission Open
Applied for EWS Yes
Person with Disability Not Applicable
Defence Type Not Applicable
Is Orphan Candidate No
Applied for TFWS Seats Yes
Minority Candidature Type No
District from which Candidate has Passed SSC Nagpur
District from which Candidate has Passed HSC / Diploma in Engineering & Technology Nagpur
Nationality India
MHT-CET Application Fee Paid (R ) 800/- Online Application Fee Paid (R ) 0/-
Qualification Details:-DWIVEDI ANKUSH AJAY (Name As Per HSC Result)
Qualification Marks Obtained Marks OutOf Percentage
HSC Physics Marks 92.00 100.00 92.00
HSC Mathematics Marks 88.00 100.00 88.00
HSC Chemistry Marks 88.00 100.00 88.00
HSC Biology Marks 91.00 100.00 91.00
HSC English Marks 89.00 100.00 89.00
HSC Aggregate Marks 538.00 600.00 89.67
SSC Board Maharashtra State Board of Secondary and Higher Secondary Education, Pune
SSC Passing Year 2019 SSC Seat Number J061157
Qualifying Exam HSC HSC Passing Status Passed
HSC Board Maharashtra State Board of Secondary and Higher Secondary Education, Pune
HSC Passing Year 2021 HSC Seat Number N022680
MHT-CET 2022 Details:- DWIVEDI ANKUSH AJAY (Name As Per MHTCET Result)
Application Number 221081012 Roll No 2221300294
Physics 42.6666036 Chemistry 48.4794021
Mathematics 92.3899162 Total PCM 83.9142978
JEE (Main) 2022 Paper-1 NTA Score:-ANKUSH AJAY DWIVEDI (Name As Per JEE Result)
Appeared for JEE Yes Application No 220310395164
Physics 82.1038507 Chemistry 8.0462460
Mathematics 23.3398864 Total 35.0511764
Note : Submit one set of application form along with photocopies of documents mentioned below. FC Officer shall verify all original documents and put FC stamp with
dated Signature on all photocopies of documents and return the same set of documents to the candidate along with Receipt-cum-Acknowledgement of application form.
List of Documents Required at the time of Document Verification and Confirmation at Facilitation Center
Sr. No. Document Name
1. C er ti fi ca te of I nd ia n N at io na li ty i n t he N am e of t he C an di da te .
2. Domicile Certificate of the Candidate showing his / her Domicile State is Maharashtra.
3. Income Certificate of Parents issued by competent authority of Govt. Of Maharashtra having Annual Income upto Rs. 8 Lacs.
4. Eligibility Certificate for Economically Weaker Section In Proforma - V.
5. Statement of Marks or Certificate of Passing SSC / Equivalent Examination.
6. Statement of Marks or Certificate of Passing HSC / Equivalent Examination / Passing Marksheet/Certificate of 3 years Diploma in
Engineering and Technology .
7. Score Ca rd of JEE Ma in (Pape r - 1) 2022.
8. Score Card of MHT-CET 2022.

Declaration

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I have read all the rules o admission and In ormation brochure or admission to UG courses 2022 and on understanding these Rules, I have illed this Application
Form for Admission to First Year of Under Graduate Technical Courses in Engineering and Technology for the Academic Year 2022-23. The information given by me in
this application is true to the best of my knowledge & belief. If at later stage, it is found that I have furnished wrong information and/or forgery/Xerox copy or submitted
false certificate(s), I am aware that my admission stands cancelled and fees paid by me will be forfeited. Further I will be subject to legal and/or penal action as per the
provisions of the law.
Place : Date : 02/10/2022
Printed On : 02/10/2022 2:50:14 PM
Last Modified On : 02/10/2022 2:48:33 PM Signature of Applicant
Last Modified By : EN22198861, 157.33.102.140:49747 ( DWIVEDI ANKUSH AJAY )

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