1.Name of ApplicantPRATEEK RAJENDRA GAIKWAD

2.SexMALE

3.NationalityINDIAN

4.Date of Birth22-08-1992

5.Fathers Name RAJENDRA DAMODHAR GAIKWAD

6.Correspondence AddressB-6, NIHAR COLONY, SAIDIP NAGAR, PIPELINE ROAD, SAVEDI, AHMEDNAGAR 414003 (MS)

7.Permanent AddressB-6, NIHAR COLONY, SAIDIP NAGAR, PIPELINE ROAD, SAVEDI, AHMEDNAGAR 414003 (MS)

8.Contact Details

(a) Mobile Number9403377128

(b) E-mail Addressprateekgaikwad92@gmail.com

(c) Name, Relationship and contact details of the person to be contacted in case of any emergencyRAJENDRA GAIKWADFATHERB-6, NIHAR COLONY, SAIDIP NAGAR, PIPELINE ROAD, SAVEDI, AHMEDNAGAR 414003 (MS)

9.Details of the Course of Study

(a) Name of the courseBACHELORS IN MECHANICAL ENGINEERING (BE-MECH)

(b) Duration4 Years

(c) Name of the InstitutionG. H. RAISONI COLLEGE OF ENGINEERING AND MANAGEMENT, CHAS, AHMEDNAGAR

(d) Date of joining Institution

(e) Expected Date of Completion

10. Educational Qualifications:

Name of Board/University/institutionExam PassedYearDivision/GradeSubjects

(i)KEDNRIYA VIDYALAYA NO.1, AHMEDNAGAR (CBSE)SSC200886.2% Eng, Hindi, Maths, Science, Social Studies

(ii)GOVT. POLYTECHNIC, AHMEDNAGAR (MSBTE)DIPLOMA IN MECHANICAL ENGINEERING (DME)201170.2%Machine Design, Ind. Fluid Power, MQC,

11.Subjects of Specialization/InterestMachine Design, CAD/CAM, FEA, etc.

12.Projects Preferences, if any-

13.Brief Note as to why you want to take up this InternshipTo familiarise myself with the on-ground requirements, challenges of mechanical engineering before joining any full-time job so that Ill become competent during my future career.

14.Details of Scholarship, availed by you along with quantum of amount and durationNil

15.Name and contact details of two references from the present Institution or the institute last attended

(i)

(ii)

Place: Date: Signature of the Applicant

DECLARATION I certify that the above mentioned information furnished by me is true to the best of my knowledge and belief. I also agree that in event of any misinterpretation and/or falsification of information, my internship shall be liable for termination without any further notice without prejudice to any other administrative/legal proceedings that the Ministry may deem fit to initiate.

Place: Date: Signature of the Applicant