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M.S.B.T.E.
  ONLINE ADMISSION FORM:
ONLINE APPLICATION FORM 2009-10
1) Name in CAPITAL Letters:
Surname
First Name
Middle Name
Father's Name
2) Marks obtained at S.S.C. Examination (Add remaining subjects in blank blocks provided)
Subject
Elementary
Algebra &
Geometry
Gen. Science
or Physics & Chem.
English
All subjects total mark
Marks
obtained
Maximum
Marks
3) Other details (strike out which is not applicable):
3.1) Have you passed S.S.C./ Std. X from Maharashtra: 3.7) Date of Birth:
3.2) Domicile of Maharashtra: 3.8) Is your Father Central Government Employee?
3.3) Have you passed S.S.C./ Std. X with Technical subjects? 3.9) Gender:
3.4) Have you passed H.S.C./ Std. XII with M.C.V.C.? 3.10) Is your Father State Government Employee?
3.5) Have you passed Intermediate Grade drawing Examination? 3.11) Category:
3.6) Are you physically handicapped? 3.12) Caste:
    3.13) H.S.C.( XII Std.) Science:
    3.13.1) Exam Percentage with marks:
4) State your choice of courses in the order of preference: 1) 2) 3)
4) 5)
5) Give details of schools attended for three years prior to and inclusive of passing S.S.C.:
Sr. Name of the school attended with complete postal address
Std./ Class
Academic year
1.
Std. VIII
2.
Std. IX
3.
Std. X
6) Father/ Guardian's Details:
6.1) Full Name:
6.2) Relationship of guardian with the candidate:
6.3) Occupation: Total Annual Income Rs.:
6.4) Address for Correspondence:
6.4.1) Permanent Address:
Place/ City: District:
State: Pin Code: (Optional)
6.4.2) Correspondence Address: Use same Address as that of Permanent Address:

Place/ City: District:
State: Pin Code: (Optional)
Contact Phone No (With STD Code): (Optional)
E-mail Address: (Optional)
7) Mother's Name:
8) Total number of attested Copies of certificates attached:
Declaration (Candidate):
1) I have read all the Rules of admission for the First/ Second year and after understanding these rules, I have filled in this form of application for the academic year.
2) The information given by me in my application is true to the best of my knowledge and belief.
3) I have not been debarred from appearing at any examination held by any Government constituted or Statuory examination authority of India.
4) I fully understand that the offer of a course of branch of Engineering/ Technology will be made to me depending on my inter se merit and availability of a seat at the time of scruntiny of my application, which when I am called for it.
5) I understand that no other document other than those attached to the application form will be entertained for the purpose of claims/ concessions/ weightage etc. in connection with my admission.
6) I hereby agree to confirm to any rules, Acts and Laws enforced by Government and I hereby undertake that so long as I am a student of Polytechnic/ College I will do nothing either inside or outside the Polytechnic/ College which may result in desciplinary action against me under the rules, Acts and Laws.
7) I fully understand that the Principal of Polytechnic/ College where I would be admitted will have full liberty to expel me from the Polytechnic/ College for any infringment of the Rules of Conduct and descipline and the undertakings given above.
8) I am fully aware that institute is going to charge higher fees for different courses at different levels and I hereby agree to pay the fees as approved by Shikshan Shulka Samiti Bandra (E) Mumbai.
9) I shall not ask for transfer from aforesaid Polytechnic to any other Polytechnic under any circumstances.
10) I shall not ask any kind of financial assistance and help from Government for my education in aforesaid Institute.

Place:
Date: 22-7-2017


Declaration (father/ Guardian):
1) The particulars furnished by my son/ ward in this application form are correct to the best of my knowledge.
2) I undertake and bind myself to pay on behalf of my son/ ward such fees, charges etc. which the college to which he/ she is admitted may levy from time to time, by due date and in the event of failure on my part and/ or on the part of my son/ ward, the Principal of the Polytechnic/ College may take such action against my son/ ward, as he may deem fit.


Please do not make multiple Submission. Only One Application form per person will be accepted. Please review your form carefully before submitting. You may also keep a Printed Copy of this Form by Clicking here.This form is being treated as your intent for admission.



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