Pin : Manjari (Bk.), Pune - 412 307.

Vasantdada Sugar Institute

REGISTRAR
From :
To Application Form
attach it with the
on this card and
complete ADDRESS
here write his/her
stamp
Candidate must
Affix
VASANTDADA SUGAR INSTITUTE
MANJARI (BK.), PUNE : 412 307.
ACKNOWLEDGEMENT CARD FOR
ADMISSION TO A.V.S.I. PROGRAMM - 2011
*
Reg.No. Date :
Received an Application Form for the above mentioned admission from
(Candidate to write his/her name above in block letters)
* (Please quote the registration number in your future correspondence)
REGISTRAR
 NOMINATION FORM - 2011

(APPLICABLE FOR ADMISSION TO : ST, IFAT, SED, SEC, SMC,SBC & JSC PROGRAMMES ONLY)

1. Name and Full Address of the factory :

2. Name and designation of person signing the nomination form :

3. We have pleasure in nominating Shri.

for programme.
(Mention the Programme to which admission is sought)

We Certify that :

1 We will provide in plant training facilities to the nominated candidate in our factory, when desired by
and as per rules and guidance of the Institute.

2 We will give preference to our nominee on successful completion of his training at the Institute
for employment on a suitable post subject to the availability of vacancies.

3 The candidate nominated is a regular employee of our factory and he shall continue to be governed
by our factory rules in respect of pay and other service conditions when deputed to training by our
factory.

Strike off whichever is not applicable

Date SEAL OF FACTORY SIGNATURE

Chairman/Managing Director/
General Manager
 VASANTDADA SUGAR INSTITUTE
Manjari (Bk.), Pune : 412 307.
APPLICATION FORM FOR ADMISSION
2011

No.
Last date for the Receipt of Application
Photograph
from duly completed : 06/06/2011

PROGRAMME :

(Mention the Programme Code in BLOCK LETTERS as per section 7.1)

a Full Name :
(in BLOCK LETTERS)

b Name of Father/Guardian :
i Occupation :
ii Annual Income (Rs.) :

c Address i Permanent :
(with Pincode)
(in BLOCK LETTERS)

ii Address :
(Mailing address with
Pincode)
(in BLOCK LETTERS)

iii a Tel.No. :
b Fax :
c E-mail :

d Place of Birth Date of Birth

e State of Domicile

f Scheduled caste/Scheduled Tribe YES / NO

(if any, please attach necessary certificate)
g Local Guardian/
contact person,
in Pune

i Name :
ii Address :
iii Tel.No. :

h i Have you applied for the course previously

ii If Yes give details :

i Educational Qualification : (Attach Photo copies of Certificates and other documents)

Sr. Examination Board/ Year Subjects Percentage Division

No. passed University Studied of Marks Class/
Obtained Grade
Obtained

1 Matriculation/
S.S.C.

2 12th Std./
Inter Science/
H.S.C.

3 First year
of B.Sc.

4 Second year
of B.Sc.

5 Final year
of B.Sc.

6 Final year
of B.E./B.Tech.

7 M.Sc./M.Tech.

8 Diploma

9 Any other
Examination
j Experience Details : (Attach authentic certificate)

Sr. Name of the Period of Designation Nature of Duties

No. Organisation Service

(Attach separate sheet if required)

k Extra curricular activities :

and special achievements

UNDERTAKING

1 I hereby declare that the entries in this form are true to the best of my knowledge and belief
that in the event of my being selected for admission to the Institute. I do hereby promise to
abide by the rules and discipline of the Institute.

2 In case I take hostel admission I shall abide by all Hostel Rules and Regulations.

Particulars of Demand Draft : i D.D.No.

ii Name of the Bank
iii Amount

Date : ____________ SIGNATURE OF THE APPLICANT

Enclosure : 1 _____________________ 4 ______________________

2 _____________________ 5 ______________________

3 _____________________ 6 ______________________