Final Print Form

Application Form No.

Photo

Application Help Centre Name (For Application Receipt Center Use Only)

Personal Information Candidate's Name Father's/Husband's Name Occupation of Father/Parent

Passport Size Photo Dimensions (4.5cm X 3.5cm-1.78" X 1.38")

Address and Contact No.

Signature Mother's Name Date Of Birth

Gender

Domicile

Domicile Option

Domicile State(Only For Out of Maharashtra Candidate):

Category & Application Receipt Center Details Application Receipt Center (ARC ) Whether belongs to economically backward class

Category

Original Category

Caste

Sub Caste

Other Reservations

Non Creamy Layer

Academic Details SSC Percentage

HSC/Agriculture Polytechnic Exam Seat No.

89.20

Name & Address of HSC/Agriculture Polytechnic passed Month & Year of Passing Marks in HSC / Diploma / Agriculture Polytechnic Subject wise Marks

05/2016 (Max Marks)

Total No. of Attempts

1

(Marks Obtained)

Faculty

SCIENCE

(Percentage)

900 Physics

Chemistry

Code of Optional Subjects Vocational Subject Codes

1 Out Of 6

Biology

Maths

English

Weightage Details

Final Print Form

Sr. No.

Weightages

1

Village form 7/12 extract / Khasara for the year 2014-15 or 2015-16 issued by the Talathi / Patwari

2

Certificate of Landless Agricultural Labour issued by the Tahasildar / Naib Tahasildar.

3

Certificate of Fisherman issued by Tahasildar / Naib Tahasildar

4

Certificate Of Agriculturist issued by the Tahasildar / Naib Tahasildar

5

N.C.C. B or C Certificate ( Air / Naval / Army wing) issued by the Commandant (Passed during XI or XII Standard).

6

N.S.S. Certificate of 240 hrs. / N.S.S. Special Camp issued by the competent authority.

7

Employers Certificate being son / daughter of Agricultural University / MCAER employee.

8

Certificate of Debate / Essay / Elocution of state Level Competition issued by concerned Organisation.

9

Sport Certificate(International / National / State / District) Level

10

Certificate of Diploma in Agriculture Science of Rural Institute Amaravti or Wardha.

11

Certificate of Diploma in Agriculture School.

12

Crush and Preschool Management

13

Mechanical Maintenance

14

Animal Science / Animal Science & Technology

15

Academic Points (Percentage)

16

Weightage Points

17

Total Points

18

Eligible For Course

Application Form No

B.Sc. (Agri)

B.Sc. (Hort)

B.Sc. (Forestry)

B.F.Sc.

B.Tech. (Engg)

No

No

No

No

Yes

2 Out Of 6

B.Tech. B.Sc. B.Sc. B.Sc. (Food (Animal (Home B.B.A(Agri) (Agri.Bio) Tech.) Husbandry) Sci.)

No

No

Yes

Yes

No

Document Details

Final Print Form

Application Form No

(i) Domicile Certificate issued by the Competent Authority from Maharashtra / School / Agriculture Polytechnic Leaving Certificate containing place of birth from Maharashtra / birth Certificate issued by the competent authority from Maharashtra. (ii) For Other State candidates, Domicile Certificate / Residential Certificate / Residence and date of birth Certificate issued from the competent authority. S.S.C . (X std.) Mark sheet / Statement of marks.

H.S.C . (XII) std. or Diploma or Agriculture Polytechnic Mark sheet / Statement of marks. College or Agriculture Polytechnic Leaving/ Transfer Certificate (last attended)/ Bonafide certificate of the college where admission has already been taken. The candidate admitted in last academic year in any Agricultural University in Maharashtra if again applies to seek the admission for the current academic year for the first year degree course, then the Bonafide Certificate issued from the last attended respective College/Institute will be considered. Caste Certificate issued by competent Authority designated in the State. Caste Validity Certificate or receipt of submission to Scheduled Tribe Caste Scrutiny committee with undertaking as per mentioned in Appendix ‘G’ for Scheduled Tribe Candidates. Caste Validity / Setu No : Caste Validity/ Setu receipt issue at place : Non Creamy Layer Certificate issued on or after 1st April 2016 or valid upto the date of submission of application form by the Competent Authority Non Creamy Layer Certificate Valid Upto Date : 03/02/2017 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 Defense 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 / OR the competent officer, empowered (with letter of competent officer if empowered þ) 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)’ for the year 2014-15 or 2015-16 issued by the Tahsildar/ Naib Tahsildar OR issue in the format available with Tahasildar / Naib Tahasildar 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. (i) Village form 7/12 extract / Khasara for the year 2014-2015 or 2015-2016 issued by the Talathi / Patwari showing that the land is in his/her name or in the name of parents/ grand parents. Village form 7/12 extract / Khasara for the year : 2014-2015 (ii) In case parents are not alive, the 7/12 extract should be in the name of family head and the candidate should attach an Affidavit of family head on Stamp Paper of Rs.100/- (Hundred only) of the agricultural land holder stating that the applicant has legitimate share in the agricultural land. (iii) In case the extract is not in Marathi/Hindi or English, a certified translation should be attached. (iv) Affidavit submitted by the mother of the Candidate of her father on stamp paper of Rs.100/- (Hundred only)stating ancestral land in her name alongwith 7/12 extract thereof. ‘Certificate of Landless Agricultural Labour’ issued by the Tahsildar/ Naib Tahsildar stating that the principal means of livelihood of the parent is manual labour on agricultural land. (This certificate should not be in the name of applicant.) However, “Agriculturist” (AG) category will not be given to Landless Agricultural Labour. ‘Certificate of Fisherman’ issued by Tahsildar / Naib Tahsildar / Port Officer stating that the source of income is from fishing only. NCC B or C Certificate ( Air/ Naval/ Army wing) issued by the Commandant (Passed during XI or XII Standard). Certificate of participation in Sports/ Games issued by the District Sports Officer that the applicant has participated the College at XI and / or XII Std. / Agriculture Polytechnic in International, National, State, District competition. ‘NSS Certificate’ issued by the competent authority in respect of Jr. College or Student’s Welfare Officer or Programme coordinator for admission to under graduate courses. Employers Certificate being son/daughter of Agricultural University/MCAER employee. Certificate of Debate / Essay/ Elocution issued by the District Sports Officer that the applicant has represented the Institute at XIth and / or XIIth Std./Agriculture Polytechnic in District, State, National, International level tournaments. Mark sheet/Certificate of Diploma in Agriculture Science of Rural Institute Amaravti or Wardha. Mark Sheet / Certificate’ of Diploma in Agricultural Technical School. ‘Mark Sheet / Certificate’ of Diploma in Agricultural Engineering from Jammu and Kashmir state. ‘Economical Backward Class (EBC) Certificate’ issued on or after 1st January,2016 issued by the concerned Tahsildar.(This provision is only for the students admitted through centralised admission process in non grant Colleges.) Economical Backward Class (EBC) Certificate Issued Date : 05/08/2016 ‘Migrant/ Displaced Students from Jammu and Kashmir State’ should submit Certificate from the competent authority as mentioned in Government Resolution No. AGU-2095/23106/CR-181/19-A, dated 5/9/1996. Affidavit regarding displacement will not be entertained. ‘No objection Certificate’ from employer if employed . Undertaking in ‘Appendix I’ regarding cleanliness habits Self Declaration in ‘Appendix F’ regarding authenticity of self attested copies.

- - - - - - - - - - - - - - - - - - - - - - - - - - - For office use only - - - - - - - - - - - - - - - - - - - - - - - - - - I hereby declare that I have checked all the documents enclosed with the Application Form against the values entered by the applicant in the online application form. I have recorded my observations in the system. Name of the ARC representative: (Sign of ARC representative) 3 Out Of 6

College Options Details

Application Form No

Final Print Form

Note : Example to read [Preference No1]-(College Code 1) | [Preference No2]-(College Code 2) [1]-(15124) | [2]-(15203) | [3]-(15204) | [4]-(15205) |

Declaration 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 UG Admission Process if any information being found false or incorrect I shall be liable for action taken by MCAER. Place : Signature of Candidate Date :

Payment Details Application Date Amount

:

Payment Type

:

:

Bank Name

:

Branch

:

DD Number

:

Date

:

4 Out Of 6

Appendix F

5 Out Of 6

Please cut this section and paste it on Envelope to be sent to ARC Center.

To:

From:

6 Out Of 6