BVDU - Amplify DITM

To, Chief Operations Officer, BVDU - Amplify DITM, Pune- 411043 Date: 25-07-2012

REGISTRATION OF 2ND YEAR/3RD YEAR FOR ACADEMIC YEAR 2012 - 13

Application for Registration to Name (as per BVDU marksheet): Date of Birth: 1988-07-17 Mobile No.: 7620986633 BloodGroup: OVehicle Name: KARIZMA Second year. Course Name: PGDIIBM( Sem - 3 ) Sandeep Jai Narayan Kumar Roll No.: IIBM/11/013 PRN: 1100004437 Email ID: SANDEEPSINGH1497@GMAIL.COM Vehicle No.: 1393

Permanent Address: Local Address: HAUSE NO-A|7,LOYABAD NO-8,LOYABAD MORE,CISF CHECK POST,PO-BANSJORA,DIST-DHANBAD.JHARKHAND.828101

DHANBAD, JHARKHAND, 828101 INDIA Details of Parents: (to be filled in by student): Name of Father: shri JAI NARAYAN KUMAR Occupation: GOVT JOB Work Company: Designation: Nature of Job: Phone No.: Mobile No.: Email ID: Name of Mother: USHA DEVI Occupation: Home maker Work Company: Designation: Nature of Job: Phone No.: Mobile No.: Email ID: Details of Marks: (to be filled in by student) Sr. No. 01 02 Examination Semester I Semester II Marks Obtained 439 263

, Maharastra, India

9835137474

Total Marks 800 800

Percentage 54.88% 32.88%

Result Fail - ATKT Fail - ATKT

Office Use Only

Students Section: (to be filled in by Students Section) Original Documents: Permanent ID Card Status: Previous Year Marksheet Status: Signature: Library Details: (to be filled in by Library Section) Previous Year Clearance:

Signature of Librarian:

Details of Current Year Fees Paid: (to be filled in by Accounts Section) Amount: Date of Receipt: Receipt No.: Signature of Accountant:

Remarks and Signature of Course Co-ordinator:

Following photocopies are attached with this form 1. Fee Receipt - Yes / No 2. Marksheet - Yes / No

Signature of Student

Signature of Director - Academics

ADMISSION APPROVED/NOT APPROVED

Date:

Signature of COO