5. Faculty Roll No.: 6.Enrolment No.
(M/F)
7. Date of Birth: 8.Gender 9. Hall of Residence/NRSC
10. Religion: 11. State (Code Only):
12. Special Category (If any): 13. Nationality :
14. Last Examination Passed/Appeared:
I wish to apply for registration in the following paper(s) including backlog paper(s) , (if any).
S.
No.
Paper
Code No.
Title of Papers
S.
No.
Paper
Code No.
Title of Papers
1.
7.
2.
8.
3.
9.
4.
10.
5.
11.
6.
12.
Backlog Papers
1.
4.
2.
5.
3.
6.
D D M M Y Y Y Y
PASTE
(do not staple)
Recent
Photograph
2.5 x 3 cms
to be attested
by the
Dean/Chairman
concerned
(M/F)
Name of Examination University Year Roll Number %of Marks
NOTE : 1. Entries in the Form should be in Capital Letter only.
2. Fill up the correct title and course codes. In case of any doubt verify the same from the Department concerned.
3. Student will be permitted to attend the classes and/or appear in the examination for registered courses only.
Cont……
16. Only for Research Students
17. Residential details of the student for the session ____________
Hall …………………………………….………….. Hostel …………………………..………………………….. Room No. ………….………
18. Fee Paid Rs. ………………………………Vide C.R. No. …………………………………………. Date ……………….……………………….
Cashier Provost/Co-ordinator
19. Allowed continuation in the Class ……………………………………………………………………………………………………………....
Faculty/Class Roll No. ………………………………………………………………………………………………………………………………………..
For the session ………………………………………………………Dated ………………………………………………………………………………..
DEAN/PRINCIPAL/COORDINATOR
Signature of Student
15. (a) Permanent Address of the student
……………………………………………………………………….
……………………………………………………………………….
……………………………………………………………………...
……………………………………………………………………...
District ………..………………………………………………..
Pin Code ………………………………………..……………..
Contact No. …………………………………………………..
15. (b) Local Address of the student
……………………………………………………………………….
……………………………………………………………………….
……………………………………………………………………...
……………………………………………………………………...
District ………..………………………………………………..
Pin Code ………………………………………………………..
Contact No. ……………………………………………………
Department Reg. No. Date Name of Supervisor