Kapol Vidyanidhi College

Affiliated by Mumbai University

Mahavir Nagar, Kamla Vihar Sports Club Lane,
Near Poisar Gymkhana, Kandivali (W), Mumbai - 400 067,
Tel. : 022-28614719 / 28661143 | kvihmct@yahoo.com | www.kapolcollege.in



(to be filled in BLOCK LETTERS)

1. Personal Information Section

Last Name / Surname First Name Middle Name

Citizen of (Country Name).:
Address of Correspondence:
City.: Pincode.: State.:

Permanent Address (Write only if different than "Address for Correspondence) :
City.: Pincode.: State.:

2. Legal Reservation Information Section
Domicile of State.: Category.: If reserved.:
caste.: Sub - Caste.: If Physically Challenged.:

3. Social Reservation Information Section

Tick (3) whichaver is applicable, Write nane of supporting document attached in section 6

Ex-Serviceman / Ward of Ex-Serviceman
Active-Serviceman /Ward of Active-Serviceman
Freedom Fighter /Ward of Freedom Fighter
Occupation of the Guardian
Annual Income of the Guardian (Rs.)

4. Educational Details Section

Write 'YES' in last column, againat the qualifying examination, on basis of which seeking admission to the said course.
Write NO in front of other examinations

Examination Name of Board or University Name of School / College Date of Passing Examination Seat No. Degree / Passing Certification No. Grade / Total Marks Obtianed Out of Qualifying Examination (YES / NO)
Enter previous semester grades

5. Guardian Information section
Guardian Name : Occupation of Guardian : Phone No.:
Relationship of guardian with applicant : Annual income of the Guardain (Rs.) (Last financial year) :

6. Attached Documents and Certificates Section

Carry the following documents to the college at the time of admission. (Carry following documents only if applicable)

1. Photograph 8 Nos.
2. Passing Certificate of Previous Class/ Statement of Marksheet Previous Class Attested Copy (2 Copy each)
3. Marksheet/ Passing Certificate of Std. 12th. Attested Copy (2 Copy each)
4. Original Leaving Certificate. Attested Copy (2 Copy each)
5. Tahsildar Income Certificate. Attested Copy (2 Copy each)
6. Ration Card. Attested Copy (2 Copy each)
7. Certiticate of Caste with Category. Attested Copy (2 Copy each)
8. Non Creamy Layer Certilicate. Attested Copy (2 Copy each)
9. Affidavit for changed Name/Marriage Certificate/Govt. Gazette. Attested Copy (2 Copy each)
10. Certificate for Physically Challenged. Attested Copy (2 Copy each)

7. Other information Section

Mother Tongue : Employment Status : Hobbies and Other interests :

8. Declaration by Student

I hereby declare that, I have read the rules related to admission and the information filled in by me in this form is
accurate and true to the best of my knowledge. I will be responsible for any discrepancy, arising out of the form any document the final admission will signed by me and undertake that. in absence of not be granted and / or admission will stand cancelled.

Place                                         Signature of Student
9. Declaration by Guardian

T have permitted my son / daughter/ward to join your college. The knowledge. information supplied by him / her is correct to the best of my I have acquainted myself with the rules and fees, dues to my son/ daughter/ward and to see that he/ she observes.

Place                                       Signature of Guardian


Note :

1. You will get PDF after submitting this form.
2. Save PDF and take print out and carry it while admission
3. Confirm your Admission by paying Rs.300/- in the given below bank details.

Form Designed by @Vaibhav Vakotar (+917738123911)