Application Form No

MCAER-PG000008
(For Application Receipt Center Use Only) 1
Personal Information
Candidate's Name Mr. ADINATH RAMDAS KEKAN
Father's/Husband's Name ENTER NAME ENTER NAME ENTER SURNAME
Occupation of
Father/Parent
BUSINESS
Address and Contact No
Mother's Name ENTER NAME ENTER NAME ENTER SURNAME
Date Of Birth 01/03/1992
Domicile
Gender
Domicile Option
Domicile State(Only For
Out Of Maharashtra
Candidates):
Signature
Photo
Reservation Details
Category:
Other Reservations:
Non Creamy Layer:
BY BIRTH MAHARASHTRA
MALE
5,AKSHAY APARTMENT
UNIVERSITY ROAD,OPP ABC SCHOOL, City : PUNE,
Taluka : PUNE, District : PUNE,
State : MAHARASHTRA, Pincode : 411008.
Phone No : ,Mobile No : 9665095746,9822012345
Email : test@gmail.com
Caste:
MAHARASHTRA COUNCIL OF AGRICULTURAL EDUCATION
AND RESEARCH
Passport Size Photo
Dimensions
(4.5cm X 3.5cm-1.78"
X 1.38")
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Considered Category:
EBC: Religion :
Cast Validity:
Academic Details
b KOSHTI No Yes SBC
SBC NONE, No
College Name
City:PUNE,
District:PUNE,State:MAHARASHTRA
College City
Category of Admission to U.G. course
C.G.P.A. in qualifying Examination
Employed?
COLLEGE OF AGRICULTURE PUNE
College Address
PUNE
Bachelor's Degree Course Completed
Number of Attempts In UG Final Exam
B.Sc.(Horti.)
OPEN
'No Objection Certificate '(NOC) from your
employer ?
1
Yes Yes
5.40
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Applied Faculty
Sports Participation
MCAER-PG000008
Weightage Details
Sports Points : 0.20
Sports Weightage Point : Total Points : 0.20 0.25
Faculty Name Seat Number CET Marks 70% of CET Marks
01010016 Agriculture 49.5 34.65
Second rank in International Sports Competition : 0.20
Weightage Details Weightage
N.S.S. Certificate of at least 240 hrs./N.S.S. Special Camp issued by the competent authority.(during Under Graduation). 0.12
NCC B or C certificate. 0.12
Document Details Application Form No MCAER-PG000008
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Mark sheet / Grade Card of qualifying examination.
College/ Institute Leaving/ Transfer Certificate (last attended)/ Bonafide certificate of the college where
admission has already been taken.
NCC B or C Certificate ( Air/ Naval/ Army wing) issued by the Commandant (Passed during XI or XII
Standard).
NSS Certificate issued by the competent authority in respect of Jr. College or Students Welfare Officer
or Programme coordinator for admission to under graduate courses.
(A)Certificate of Games / Sports that the applicant has participated in 'Krida Mahotsav' Sports
Tournaments issued by the Students Welfare Officer / Vice Chancellor / competent authority of the
organising University
Certificate of Debate / Essay/ Elocution issued by the District Sports Officer that the applicant has
represented the Institute at XIth and / or XIIth Std. in District, State, National, International level
tournaments.
Domicile Certificate or Birth Certificate issued by the Competent Authority OR School Leaving Certificate
containing place of birth for Maharashtra and other State candidates too.
Caste Certificate issued by competent Authority designated in the State.
Caste Validity Certificate issued by the Competent Authority.
Non Creamy Layer Certificate issued after 1st April 2013 or valid as on date of admission.
Whether the Certificate of the Freedom Fighter issued in favour of parents/Grand parents of the
Candidate is issued under the signature of the Hon. Prime Minister/Chief Minister, Maharashtra State.
Certificate of Defence Personnel (DP) issued by the Zilla Sainik Welfare Officer/Discharge Certificate
issued by the Officer Commanding the Regiment or Serviceman Certificate issued by the Competent
Authority.
Certificate of Physically Handicapped (PH) issued by District Civil Surgeon or equivalent Government
hospital/ Medical board.[The percentage of disability shall not be less than 40% in case of candidate
seeking reservation for physically handicapped category.]
Certificate of Project Affected Person (PAP) issued by District Resettlement Officer/ Rehabilitation
Officer of Government of Maharashtra in the prescribed form that his/her parents/grand parents land has
been acquired by the Government for Agricultural University/ Irrigation/ Power/ Defence Project having
the name of beneficiary.
Certificate of Agriculturist (AG) issued by the Tahsildar/ Naib Tahsildar showing that the applicant or
his/her parents or grand parents (Paternal) is/ are owner or tenant, holds agricultural land and whose
main source of income is derived from personal cultivation of land.
Economical Backward Class (EBC) Certificate issued on or after 1st January,2013 issued by the
concerned Tahsildar.(This provision is only for the students admitted through centralised admission
process in non grant Colleges.)
No objection Certificate from employer if employed .
Undertaking in Appendix J regarding cleanliness habits
(B) In case of international Competition, certificate issued by concerned competent authority of
Association.
(C) International games competition :
(i) Olympic games (ii) Common wealth games (iii)Common wealth youth games (iv)Asian games
(D) Certificate for National Championship Competition
(E) Certificate for State Championship Competition
Scrutiny Student Details of Certificate / Documents No.
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3.
4.
5.
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8.
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College Options Details
Application Form No MCAER-PG000008
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I hereby declare that all the information furnished by me in this Application Form is true and complete to the best of my
knowledge and belief. I understand that entries made by me in this Application Form are final and binding on me. I
Further declare that in the PG Admission Process if any information being found false or incorrect I shall be liable for
action taken by MCAER.
Declaration
Place :
Date :
(ADINATH KEKAN)
Signature of Candidate
Payment Details
Note : Example to read [Preference No1]-(College Code 1) | [Preference No2]-(College Code 2)
Payment Type
Amount
Branch
Bank Name
DD Number
12/08/2013
Date
:
:
:
:
:
:
:
Application Date
To:
Kalp Technologies Pvt. Ltd.,
Punit Yash Arcade,4th floor,,
Office No.11,
Near Kothrud Bus Stand,
Karve Road, Kothrud
City : PUNE,
Pincode : 411038
From:
ADINATHKEKAN,
5,AKSHAY APARTMENT
UNIVERSITY ROAD,OPP ABC SCHOOL,PUNE,
PUNE,PUNE,
MAHARASHTRA, 411008.
Please cut this section and paste it on Envelope to be sent to ARC Center.
MCAER-PG000008
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