Photo
Shri Vile Parle Kelavani Mandal's
Usha Pravin Gandhi college of Arts, Science and Commerce
Signature
Student Number Vile Parle (West), Mumbai - 400 056
53014240010
Academic Year : 2026 - 27
Last Year's Roll No Admission Application Form for
D009 Third Year BACHELOR OF ARTS (FILM, TELEVISION AND NEW
MEDIA PRODUCTION)
ABC ID 416904444841 New Roll No.
Personal Details
First Name Middle Name Last Name Mother's Name
Mr VIVEK RAJESH GANJU KAVITA
Gender Male Date of Birth Jun 13, 2006
Blood Group A+ Nationality Indian
Mother Tongue HINDI Religion Hindu
Local Address for Correspondence Aadhar Card No.
Address Line 1 ROOM NUMBER 212 BUILDING NUMBER 13 Address Line 2 SWATANTRA CHS LALLUBHAI
COMPAUND
Address Line 3 MANKURD WEST City Mumbai
State Maharashtra Nearest Railway Station GOVANDI
Pincode 400043 E-mail ID Vivek.g130606@[Link]
Telephone No. 9594158399 Students Mobile No. 9702988095
State of Domicile : Caste : General Category (GN)
Sub Caste : GENERAL Disability (If any Please Mention)
Particulars of Parent / Guardian:
Office Address : 101,102, NAVKAR BHAVAN, ROAD NO.7,DAULAT NAGAR, BORIVALI (EAST),MUMBAI-400066,
Maharashtra,India
Phone No : 02228940098 Mobile No : 9594158399 E-Mail ID : [Link]@[Link]
Occupation of the Parent / Guardian : Service Annual Income of the Parent / Guardian (Rs.): 240000.00
Other Information
I wish to join : NCC / NSS / DLLE / Any other please mention
Social Reservation : (If any specify) ________________________________________________________________
The Principal,
I wish to apply for admission offered to THIRD YEAR BACHELOR OF ARTS (FILM, TELEVISION AND NEW MEDIA
PRODUCTION). I have not registered myself at any other institute for any course study offered by the University of Mumbai or any other
University. The information filled by me in this form is accurate and true to the best of my knowledge. I will be responsible for any
discrepancy in the form signed by me.
IMPORTANT
Ragging is strictly prohibited. Students indulging in ragging will be punished as per The Maharashtra Prohibition of Ragging Act,
1999 (Mah. XXXIII of 1999) Published in Maharashtra Govt. Gazette on 15th May 1999'. Such students will also be expelled from
the college and F.I.R. will be lodged with the police against them. Moreover, it will be mentioned in the college leaving certificate of
such students that they are expelled because of their indulgence in ragging.
The Students found guilty of ragging earlier will not be admitted to this college.
As per the UGC Regulations, each student and every parent has to submit an online undertaking of Antiragging in every academic
Year at [Link] & [Link]
We state that as per UGC regulations, we have submitted an online undertaking on [Link] & [Link]
Photograph Photograph Photograph
(Father) (Mother) (Guardian)
Date : ___________ Student's signature Father's signature Mother's signature Guardian's signature
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FOR OFFICE USE ONLY
DD No. Subject Code C 1
Name of the Bank Admitted Provisionally
Receipt No. Signature with Date : ____________________________________________
Receiver's Signature Name : _______________________________________________________
Preference Details Form Submitted on : 09.06.2026 Time : 16:38:52
Semester Course Title Preference No.
SVKM's
Usha Pravin Gandhi college of Arts, Science and Commerce
Date: _____________
To
The Principal
SVKM's Usha Pravin Gandhi college of Arts, Science and Commerce
Vile Parle (W),
Mumbai - 400 056
Respected Madam, Undertaking for the attendance
I, _______________________________ parent/Guardian of_____________________________, the student / learner of your college who is
studying in Class __________ Div. ________ SAP No. ______________I am aware of the attendance rules of UPG College, The college
rules state that learner is expected to attend 100% lectures, practicals and tutorials conducted for every course in each semester. Every
bonafide learner shall ordinarily be allowed to keep terms for the given semester in a program of his/her enrolment, only if s/he fulfills the
criteria of at least seventy-five (75%) attendance as an average of total number of lectures, practicals & tutorials conducted for all
the courses taken together in every semester
I am further given to understand that in case my ward does not have the required attendance as per the rules as stated above, he/she will not
be granted the term of the said semester in the said academic year and the learner will not be permitted to appear for the Semester end
examination.
I hereby assure and confirm that my ward will attend all Online and offline lectures, practicals and tutorials on regular basis. In case my
ward does not meet the requirement of attendance as per the above stated norms, the college can take appropriate action in accordance to its
guidelines and can debar him/her from appearing in Semester end examination for which I shall have no objection to the same.
We hereby agree to abide by the college timings as per time table allotted which also includes online and offline lectures, practicals tutorials
and seminars conducted.
We are also given to understand by the College authorities that the attendance data of the previous month would be conveyed through the
college notice board/students' portal/Email/SMS in the first week of the month. We will take note of the same.
Ragging is strictly prohibited. Students indulging in ragging will be punished as per 'The Maharashtra Prohibition of Ragging Act,
1999 (Mah. XXIII of 1999) Published in Maharashtra Govt. Gazette on 15th May1999'. Such student will also be expelled from the
college and F.I.R. will be lodged with the police against them. Moreover, it will be mentioned in the college leaving certificate of such
students that they are expelled because of their indulgence in ragging. The students found guilty of ragging earlier will not be
admitted to this college.
My ward and I agree with above mentioned rules and regulations and will comply with the same.
We are aware that this is a computer- generated document .No signature is required.
My ward ______________________________ and I agree with above mentioned rules and regulations and will comply with the same.
Name of Student : __________________________________ Name of Parent / Guardian : _____________________________________
__________________________________ _____________________________________
Class : __________________________________ Address : ____________________________________________________
Div. : __________________________________ ____________________________________________________
Roll No : __________________________________ ____________________________________________________
Mobile No : __________________________________ Mobile No : __________________________________________________
Email Id : __________________________________ Email Id : __________________________________________________
SVKM's
Usha Pravin Gandhi college of Arts, Science and Commerce
Undertaking for Provisional Admission
To
The Principal
Usha Pravin Gandhi College Of Management,
Vile Parle (W),
Mumbai - 400 056
I __________________________admitted to class_________________understand that my admission
for the academic year 2026 - 27 is provisional and solely on the basis of merit list for the subject, I
have offered.
I will accept the subjects/combination offered to me depending on my scores, as against those opted
by me in the admission form.
“I accept that my admission will be considered as per the eligibility criteria mentioned in the ordinance
O.2310”
“I assure that I will submit the form of University of Mumbai”
“I will also submit the Migration Certificates within 15 day of admission if I belong to University other
than Mumbai University”
“I understand and agree that my admission is subject to confirmation form the University of Mumbai”
__________________ __________________
Student's Signature Parent's Signature
Name of the Student: Name of the Parent :
______________________________________ __________________________________
Class : ________________________________ Address:___________________________
Div. & Roll No : ________________________ __________________________________
SAP No.: ______________________________ __________________________________
Mobile No.:_____________________________ Mobile No.: _________________________
E-mail ID :______________________________ Email ID : __________________________
Name & Signature of the Guardian:
Address : _______________________________ Mobile No.:___________________________
_______________________________________ Email ID : ___________________________
SVKM's
Usha Pravin Gandhi college of Arts, Science and Commerce
Student Undertaking with respect to the Examination
Regulations
To
The Principal
Usha Pravin Gandhi College Of Management,
Vile Parle (W),
Mumbai - 400 056
I have read the Examination Rules and Regulations of SVKM's Usha Pravin Gandhi college of Arts,
Science and Commerce (Autonomous), carefully, and have understood its contents and their
implications. I understand that as per the rules of the Passing Standards, I will get only one chance
for re-examinations in an Academic Year, after the result declaration of the Regular End Semester
Examinations and I will have to pass in all the subjects in order to progress to the next year of the
Program.
I hereby declare that I will follow these guidelines and agree to abide by the rules and regulations of ,
in my role as a participant of this program. I, agree that the college has the right to make any changes
as it may deem fit in terms of the program content, method of delivery, evaluation norms, the
standard of passing, and guidelines. I also agree that in case of any dispute or differences, the
decision of the College will be final and binding on all the participants. I will always uphold the
values and honour of the College.
__________________ __________________
Student's Signature Parent's Signature
Name of the Student: Name of the Parent :
______________________________________ __________________________________
Class : ________________________________ Address:___________________________
Div. & Roll No : ________________________ __________________________________
SAP No.: ______________________________ __________________________________
Mobile No.:_____________________________ Mobile No.: _________________________
E-mail ID :______________________________ Email ID : __________________________
Name & Signature of the Guardian:
Address : _______________________________ Mobile No.:___________________________
_______________________________________ Email ID : ___________________________
SVKM's
Usha Pravin Gandhi college of Arts, Science and Commerce
To
The Principal
Usha Pravin Gandhi College Of Management,
Vile Parle (W),
Mumbai - 400 056
Undertaking for On Job Training, Internship & Field Project
Respected Sir/Madam,
As per National Education Policy 2020 implemented from the Academic 2023-24 the On Job Training (OJT),
Internship & Field Project are the integral part program of the Undergraduate/ Post Graduate Programmes. I will
accept the On Job Training (OJT)/ Internship & Field Project assigned by the college. If required I agree to
undergo On Job Training (OJT), Internship & Field Project work even out of Mumbai region. Also if required I
agree to pay the relevant fees for the same.
__________________ __________________
Student's Signature Parent's Signature
Name of the Student: Name of the Parent:
______________________________________ __________________________________
Class : ________________________________ Address:___________________________
Div.:__________________________________ __________________________________
Roll No.:_______________________________ __________________________________
SAP No.: ______________________________ __________________________________
Mobile No.:____________________________ Mobile No.: _________________________
E-mail ID :_____________________________ Email ID : __________________________
Name & Signature of the Guardian:
Address : _______________________________ Mobile No.:___________________________
________________________________________ Email ID : ___________________________
SVKM's
Usha Pravin Gandhi college of Arts, Science and Commerce
Undertacking for Dress Code Policy
Academic Year : 2026 - 27
I, ______________________________________________(Full Name), a learner of
__________class ________________________ (Program/Department) with SAP ID:
______________, hereby acknowledge and agree to abide by the dress code policy of SVKM'S
Mithibai College of Arts, Chauhan Institute of Science and Amrutben Jivanlal College of Commerce
and Economics (Empowered Autonomous) as outlined below:
· All the learners must wear clean, modest, and presentable clothing.
· Indecent, revealing or offensive dresses (Shorts/skirts above knee-length, ripped jeans,
crop tops above naval, spaghetti tops, vests, deep neck/back tops/t-shirts, transparent dresses
etc) are not permitted.
· Slippers (unless for medical reasons) are not permitted.
· Dress with an indecent slogan, symbol or an abuse are not permitted.
· Appropriate clothing in the laboratory is mandatory. Clean Lab. coats/aprons must be
worn in laboratories during practicals. Full sleeve outfits are strictly prohibited in the
laboratories.
· ID cards must be visibly worn at all times on the campus.
I understand that failure to comply with the dress code may result in disciplinary action, including
warnings, being sent home to change, or further penalties as per college policies.
Student's Signature: _________________________
Date: ______________
Parent/Guardian Acknowledgment:
I/We, _________________________ (Parent/Guardian Name), acknowledge the dress code policy
and will ensure my ward adheres to it.
Signature: _________________________
Date: ______________