National Fire Safety College Admission Form

SHIVA TRUST’S
NATIONAL FIRE SAFETY

MANAGEMENT COLLEGE AURANGABAD
(MSBTE INSTITUTE CODE: 1099)
College Address: Plot No .1, Sector-D, 11th Scheme, Near Wani Mangal Karyalay, Shivajinagar, Cidco, Aurangabad.
Contact No. : 0240-3554870 / 8999596936
FOR OFFICE USE ONLY

PRN No. : _______________________ Admission Date : ______________
Reg. : _______________________ Fees Receipt No.: ______________ PLEASE INSERT
PHOTO HERE
Class : _______________________ Eligibility No. : ______________
Roll No. : _______ Division: _______ Fee Category : ______________
To, SIGNATURE
The Admission Authority,
Shiva Trust,
Aurangabad.
I the undersigned, apply for admission in to __________________________________________________
1. Name of the Student (IN BLOCK LETTERS)
Surname
First Name
Father’s / Husband’s Name
Mother’s Name
Full Name in Devanagri (Marathi) __________________________________________________________
PERSONAL DETAILS:
1. Sex: Male Female 2. Religion: _______________ 3. Cast: _____________
4. Category of Caste: (S.C/S.T/N.T/O.B.C/OTHER) _________________
5. Date of Birth: Day Year 6. Blood Group:
7. Place of Birth With State: ______________________________ 8. Nationality: __________________
9. Tq. ___________________ District: _____________________ 10. Mother Tongue ______________
11. I for Indian Nation (for NRTS): _______________________________
12. Maritual Status: Married: Unmarried:
13. Name of Father / Guardian: ___________________________________________________________
14. Occupation & the total income of Father / Guardian ___________________ Rs. Pa.
15. Annual Income of Parents:
PERMANENT ADDRESS: LOCAL ADDRESS:
_______________________________________ ________________________________________
_______________________________________ ________________________________________
_______________________________________ ________________________________________
Phone No. : _____________________________ Phone No. : ______________________________
E-mail : ________________________________ E-mail : _________________________________
EDUCATION QUALIFICATION:
Yea r/ of .Name of the Name of the Marks % of Marks

Education
Passing Board & Division School I college Maths Phy. Chem. Bio. Total
COMMON ENTRANCE TEST (CET/NEET/OTHER):
Sr. No. Name of Exam State Merit No. Marks Maths Phy. Chem. Bio. Other Total
DECLARATION OF THE APPLICANT:

1. I hereby declare that the information given above is correct.
2. I agree to obey all the rules and regulations of the institute and undertake that I shall do
nothing that will interfere with discipline of the institute. Otherwise any sort of disciplinary
action can be taken against me.
3. I accept that my admission will be confirmed only on production of all the required
certificates along with transference transfer certificate from the previous college /
education institute.
4. As this course is full time Course, I will attend the entire lectures, practical sessions, etc.
which to be organized by the institute from time to time, As per rules of MUHS Nashik, Dr.
SAMU, D-BATU, MSBTE, DTE.
5. I will not claim any transfer from this institute during the entire period of the course.
6. I had fulfilled the conditions for admission to course applied for, in case my admission is
cancelled for whatsoever reasons from the Institute. I will not claim any refund of fees and
amount paid and I will not make any Claim from institut.es or Shiva Trust's Aurangabad or
any other person to any law suit.
7. I hereby submit to the disciplinary jurisdiction and the other officers and authorities of the
society and the institute shall obey and abide by the .rules made by the Head of the
institution.
8. I hereby also agreed that so long as I am students at this institute. I will do nothing inside
outside Medical College and in the hospital which may result in disciplinary action are
under the rules prevailing or that may made here after or under the acts and laws in
enacted by organization.
9. I have carefully noted that rules and procedures of admission as given in the prospectus,
which I am required to follow for getting admission to the said course and shall in matters
of interpretation accept the decision, given by the principal and / or management in
this respect as final binding.
Yours faithfully,
SIGNATURE SIGNATURE
HERE HERE
(Signature of Student) (Signature of the Parents / Guardian)
DOCUMENTS SUBMITTED: (Please tick wherever is necessary)
1. SSC Marksheet
2. HSC/ITI/MCVC Marksheet
3. Polytechnic Diploma Holder Marsksheet (All Years / Semester wise)
4. Degree Holder Marksheet / Certificate (All Years / Semester wise)
5. TC / Migration Certificate (In Case other than Maharashtra State)
6. Gap Certificate (With Notarized 100 Rupees Bond Paper)
7. Xerox Copy of Adhaar Card
8. Four Passport Size Colour Photo
REMARKS OF ADMISSION COMMITTEE WITH SIGNATURE AND DATE :

PRINCIPAL
_______________________________________________________________________ SIGNATURE
WITH COLLEGE
STAMP
_______________________________________________________________________
Note : Above Mentioned all original documents with 2 set of copy xerox each documents to submit college address
by personally / Courier/ Speed Post.

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SHIVA TRUST’S

NATIONAL FIRE SAFETY

FOR OFFICE USE ONLY

Yea r/ of .Name of the Name of the Marks % of Marks

DECLARATION OF THE APPLICANT:

(Signature of Student) (Signature of the Parents / Guardian)

DOCUMENTS SUBMITTED: (Please tick wherever is necessary)

REMARKS OF ADMISSION COMMITTEE WITH SIGNATURE AND DATE :

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