(To Be Filled by Office) Examination Centre

Form No. :______

(To be filled by Office) Examination Centre: ………………………………………

(To be filled by office)

Year of Examination: 2018 Roll No. : ………………………………………

(To be filled by office)

PART – 1 DETAILS OF CANDIDATE (To be filled in by the candidate in his own handwriting).

1. Nam in Full : ………………………………………………………………………………………………… (In Block capital) Surname Name Father’s Name

2. Date of Birth : Date ______Month ______Year______

(In words ……………………………………………………………………………………………………….)

3. Are you a MAHARASHTRIAN domicile? : Yes / No

(You are required to produce domicile certificate at the time of joining)

4. Religion: ……………………………. Caste: .……………………………….

5.* Parents / Guardians (a) Name: ………………………………………………………………………

Postal Address : (b) Address: …………………………………………………......

…………………………………………………………………..

…………………………………………………Pin…………….

(c) Phone / Mobile Nos. i) ………………………………………………………

ii) ……………………………………………………..

(d) E- Mail ID.* 1. …………………………………………………………

2. …………………………………………………………

(d) Occupation i) Father: ………………………………………………….

ii) Mother …………………………………………………

(e) Annual Income of i) Father Rs. : …………………………………………..

(Yearly)

ii) Mother Rs. :…………………………………………..

6. Details of Family: (a) Father Living : Yes / No.

(b) Mother Living : Yes / No.

7. Education :-

8. Name of the School : ……………………………………………………………………………

Last studied / studying)

9. Type of Board : ( State Board / CBSE / ICSE )

(Tick (√ ) the correct option)

10. Medium of Instruction : ( Marathi / Semi English / English )

(Tick (√ ) the correct option)

11. Games played : …………………………………………………………………………..

Achievement if any : ……………………………………………………………………………

…………………………………………………………………………….

12. Hobbies and other interests : …………………………………………………………………………….

13. N.C.C Attended. : Yes / No

14. Three self addressed (size 28 x 12 cms) Envelops Yes / No

Without postage stamps enclosed.

15. Hall Ticket enclosed: Yes / No

16. Examination Fee : Rs.450/-(To be paid by DD/Challan)

(a)  Demand Draft No______Date______Attached/Not attached.

(b) Challan No.______Date______Attached/Not attached.

(Transaction No)

DECLARATION

I hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after joining the SPI or found medically unfit then the admission is likely to be cancelled. I have read the rules and conditions carefully and I hereby undertake to abide by them. I further declare that I fulfill all the conditions of eligibility regarding age limits, qualifications, physical standards etc. as given in the advertisement and in the SPI website.

Place: ……………………. (Signature of Father / Guardian) (Signature of Candidate)

Date:………………………..Name: ……………………………………… Name: ………………………………….

FOR OFFICE USE ONLY

Verified by Supdt

Qualify / Not Qualify

Date: ……………………..

Director

SPI

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Particulars to be filled by the candidates.

Form No.______

(To be filled by Office)

SERVICES PREPARATORY INSTITUTE, AURANGABAD

SPI ENTRANCE EXAMINATION

CANDIDATE’S HALL TICKET

1. Name of Candidate : …………………………………………………………………… (In block capital) Surname Name Fathers Name

2. Date of Birth : Date______Month______Year______

3. Postal Address : ……………………………………………………………...... (with Pin code)

As per Srl No.5 ……………………………………………………………......

In main application

………………………………………………Pin-……………..

Signature of Candidate

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TO BE FILLED BY OFFICE