Photo
Shri Vile Parle Kelavani Mandal's
Mithibai College of Arts, Chauhan Institute of Science & Amrutben Jivanlal
College of Commerce & Economics
Empowered Autonomous - Affiliated to University of Mumbai
Signature
Student Number Bhakti Vedanta Swami Marg, Vile Parle (West) , Mumbai - 400 056
40712230052
Academic Year : 2025 - 26
Last Year's Roll No Admission Application Form for
A040 Third Year BACHELOR OF ARTS IN MULTIMEDIA AND MASS
COMMUNICATION
NAAC Reaccredited A++ Grade, CGPA - 3.55(November 2024)
ABC ID 948870902045 New Roll No.
Personal Details
First Name Middle Name Last Name Mother's Name
Miss NIKITA GOPAL RAWTANI BHAVIKA
Gender Female Date of Birth Feb 3, 2005
Blood Group B+ Nationality Indian
Mother Tongue SINDHI Religion Hindu
Local Address for Correspondence Aadhar Card No.
Address Line 1 B/45, SUMERU BUILDING, MHADA Address Line 2 NEAR VERSOVA TELEPHONE EXCHANGE
Address Line 3 ANDHERI (WEST) City Mumbai
State Maharashtra Nearest Railway Station ANDHERI
Pincode 400053 E-mail ID nikita.rawtani03@[Link]
Telephone No. Students Mobile No. 8080566682
State of Domicile : Caste : General Category (GN)
Sub Caste : Disability (If any Please Mention)
Particulars of Parent / Guardian:
LEATHER TOUCH, 4, MAGNUM RESORTS,NEAR HEALTH CENTRE, CANDOLIM,GOA-403515,
Office Address :
Maharashtra,India
Phone No : Mobile No : 9820661361 E-Mail ID : RAWTANIG@[Link]
Occupation of the Parent / Guardian : Business Annual Income of the Parent / Guardian (Rs.): 300000.00
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 IN MULTIMEDIA AND MASS
COMMUNICATION. 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 : 27.04.2025
Semester Course Title Preference No.
SVKM's
Mithibai College of Arts, Chauhan Institute of Science & Amrutben Jivanlal
College of Commerce and Economics (Empowered Autonomous)
To
The Principal
SVKM’s Mithibai College of Arts, Chauhan Institute of Science &
Amrutben Jivanlal College of Commerce and Economics (Autonomous)
Vile Parle (W),
Mumbai - 400 056
Undertaking for the Attendance
Respected Sir,
I, _______________________________ Parent/Guardian of_____________________________, the student / learner of your college who is
studying in Class __________ Div. ________ Roll No. _____ SAP No. ______________I am aware of the attendance rules of Mithibai
College (Empowered Autonomous), The college rules state that learner should mandatorily have a minimum of 70% attendance for each
subject / course with overall average attendance of 75%. 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 End Semester examination.
I hereby assure and confirm that my ward will attend 100 percent of 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 communicated through
the college notice board/students' portal/Email/SMS in the first week of the subsequent 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 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
student's that they are expelled because of their indulgence in ragging. The students found guilty of ragging earlier will not be
admitted to this college.
_________________ ___________________________
Student's Signature Parent's / Guardian's signature
Name of Student : ______________________________ Name of Parent / Guardian : ___________________________
_____________________________________________
Class : _______________________________________ Address : __________________________________________
Div. : _______________________________________ ________________________________________________
Roll No : _____________________________________ ________________________________________________
SAP No. : ____________________________________
Mobile No. : __________________________________ Mobile No : _______________________________________
Email Id : ____________________________________ Email Id :__________________________________________
Name & Signature of the Guardian:
Address : _______________________________ Mobile No.:___________________________
_______________________________________ Email ID : ___________________________
SVKM's
Mithibai College of Arts, Chauhan Institute of Science & Amrutben Jivanlal
College of Commerce and Economics (Empowered Autonomous)
Undertaking for Provisional Admission
To
The Principal
SVKM’s Mithibai College of Arts, Chauhan Institute of Science &
Amrutben Jivanlal College of Commerce and Economics (Autonomous)
Vile Parle (W),
Mumbai - 400 056
I __________________________admitted to class_________________understand that my admission
for the academic year 2025 - 26 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
Mithibai College of Arts, Chauhan Institute of Science & Amrutben Jivanlal
College of Commerce and Economics (Autonomous)
Student Undertaking with respect to the Examination
Guidelines
To
The Principal
SVKM’s Mithibai College of Arts, Chauhan Institute of Science &
Amrutben Jivanlal College of Commerce and Economics (Autonomous)
Vile Parle (W),
Mumbai - 400 056
I have read the Examination Guidelines of SVKM's Mithibai College of Arts, Chauhan Institute of
Science & Amrutben Jivanlal College of Commerce and Economics (Empowered Autonomous) ,
carefully and have understood its contents and their implications. I understand that as per the rules of
the Passing Standards, I will get one chance for re-examinations 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
SVKM's Mithibai College of Arts, Chauhan Institute of Science & Amrutben Jivanlal College of
Commerce and Economics (Empowered Autonomous) , 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
Mithibai College of Arts, Chauhan Institute of Science & Amrutben Jivanlal
College of Commerce and Economics (Empowered Autonomous)
To
The Principal
SVKM’s Mithibai College of Arts, Chauhan Institute of Science &
Amrutben Jivanlal College of Commerce and Economics (Autonomous)
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
Mithibai College of Arts, Chauhan Institute of Science & Amrutben Jivanlal
College of Commerce and Economics (Autonomous)
Undertacking for Dress Code Policy
Academic Year : 2025 - 26
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: ______________