Admission Form (ME-II) - Modern College of Engineering

A
ADMISSION FORM FOR THE A.Y. 2012 - 13
Application form for continuing in the college by Provisional Admission to
ME Programs
Year of the First Admission: YY Gender: M F
Branch: __________________________ (Previous Yr) Roll No._____
Admission Category: SPONSOR NON SPONSOR
GATE NON-GATE
Caste: SC ST SBC VJ NT1 NT2 NT3 OBC OPEN
Scholarship: GATE Other
PHOTO
_______________________________________________________________________________________________
COURSE APPLYING FOR:
FIRST / SECOND YEAR M. E. Academic Year
Please tick (√) for the appropriate course
PROGRESSIVE EDUCATION SOCIETY’S
MODERN COLLEGE OF ENGINEERING
1186-A, Off J.M. Road, Shivaji-nagar, Pune 411 005
Phone No. 25533638 / 648 Fax No. 020 - 25530957
Website : moderncoe.edu.in Email : pesmcoe@gmail.com
( ) M.E. (Mechanical Engineering) – Heat Power
( ) M.E. (Electrical Engineering) – Control Systems
( ) M.E. (Electronics & Tele communication) – Signal Processing
( ) M.E. Computer Engineering
Name of the student in full as expected on University Certificate / Mark List
(-in CAPITAL LETTERS)
Annexure-A
____________________________________________________________________________________________________________
Surname First Name Father’s/Husband’s Name Mother’ Name
Date of Birth ((DD/MM/YY)________________________________________________________________________
Permanent Address ________________________________________________________________________
________________________________________________________________________
_________________________________________________________________________
Tele. No. /Mobile No. ________________________________________________________________________
E-mail address ________________________________________________________________________

Name of Local Guardian ________________________________________________________________________
Address ________________________________________________________________________
________________________________________________________________________
Bank of Maharashtra
Account Number:
(Student Bank A/C. No)
Details of Last Examination:
Examination Branch / Course Month & Year Result
ME-I
Details of fees:
Fees for LAST YEAR paid Rs. Date of Payment: _
Whether paid fully in One Installment or no. of installment:
Fees if Remaining of First Yr will be paid on date: . ______
Details of current year fees:
Total Fees paid: Rs. _ _
By UTR NO/TRANSATION NO/JOURNAL NO : ________________
Fees Details checked and confirmed:
(Name & Signature of the office Staff)
Declaration and Undertaking by Candidate:
• The fees will be change subject to approval from Shikshan Shulk Samiti, Mumbai.
• I hereby undertake that if admitted, I will abide by the provisions of Maharashtra prohibition of ragging act 1999 for the
action against ragging within or outside of any educational institute.
• I will submit all necessary documents as per the requirement of concerned authority. Failing which I am aware that my
admission will stand cancelled.
• So long as I am the student of this college I hereby undertake to abide by the rules and regulations in force at present or
that may hereafter be made by the college. I will do nothing, either inside or outside the college that may interfere with
the governance and discipline of the institute.
• The information given above is true to the best of my knowledge and belief.
According to the Results of the ME-I (attached photocopy of the statement of marks of previous examination) I
request you to admit me to ME-II for the academic year 2012-13.
Place :
Date: Signature of Candidate Signature of Parents / Guardian
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Modern College of Engineering, Pune
REGISTRATION FORM FOR STUDENT:
Above student is registered in department as on (date)
Name of Faculty/Guide Sign of Faculty/Guide
Sign of HOD:
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For Office use only (Student Section ) :
Roll No. : Fees approved by SSS : (Tuition + Development Fees)
Total Fees paid : Rs. UTR No. dated :
Verified by : Sign :
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Progressive Education Society’s
MODERN COLLEGE OF ENGINEERING
1186 A, SHIVAJI NAGAR, PUNE 411 005 Ph.No :- 020,25533638,25530957
Website: www.moderncoe.edu.in
ADMISSION FEE FORM
NAME OF THE STUDENT :-____________________________________________________
MOB NO ____________________________. EMAIL ID _____________________________
ADMISSION YEAR IN THIS COLLEGE :-___________________________________________
CAST E CATEGORY :- _________________________________________________________
Annexure ‘B’
CLASS :- ____________________ BRANCH :-_______________________________________
UTR NO/TRANSATION NO/JOURNAL NO :-______________________________________
Sr.No PARTICULARS AMOUNT (Rs.)
1 TUTION FEE
2 DEVELOPMENT FEE
3
UNIVERSITY &OTHER FEE
TOTAL AMOUNT (Rs.)
BANK A/c No
20137623908
(Bank of Maharashtra)
20137639985
(Bank of Maharashtra)
Student’s Sign Parent’s Sign

UNDERTAKING
Annexure ‘C’
I, …………………………………………..………….. have taken admission in ME . Branch___________
in Modern College of Engineering, Shivaji Nagar, Pune.
I am aware that I have to attend the college and all the lectures / Practical/Workshop and all
other Academic activities regularly and have to fulfill the University criteria of minimum 75% attendance.
I promise that I will be regular in college and will fulfill the criteria of attendance and if I fail to do so I am
aware that strict Disciplinary action can be taken against me to the extent of being barred from
appearing from the exam.
Signature Parent Signature Student
Date :
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Parent Undertaking
Annexure ‘D’
I, …………………………………………………….. parent/ Guardian of …………………………………………………….
a student of ME (Branch ____________)of your esteemed Institute confirm my contact details as follows:
Address :
Contact No. (Land line & Cell No.) :
E mail id:
I assure that the above details are correct and in case of any change in any of the details I/We will
inform the college office immediately.
Place: Signature of parent
Date : Name of the student