WEST BENGAL UNIVERSITY OF TECHNOLOGY

Examination Form 2013-14 for REGULAR Students (UG/MBA/MCA)

Last Date of submission of form to the respective institutes by the students : 13 NOV 2013 Form of Application for 3rd Semester Examination 2013-14 For the Degree of B.TECH in IT Name Regno ROLL NO INSTITUTE NAME (CODE) ELECTIVE PAPERS SELECTED : 1. 2. 3. 4. 5. 6. :RITIKA KUMARI :121080110186 OF 2012-2013 :10800212065 :ASANSOL ENGINEERING COLLEGE ( 108 )

I Declare that I have fulfilled the criteria for attending the above Examinations as a Regular Candidate.

----------------------------------------------------------Full signature of the Applicant with Date I Certify that 1. The Statements made by the applicant are correct. 2.He/She was admitted to the Institute as per University regulations. 3.He/She has deligently and regularly pursued his/her studies and 4.He/She attended ...... % (in words ....................) of lectures

-------------------------------------------------------------------------------------------------------------------Signature of the Principal/Director of the Institue/ College with date and seal. N.B. 1. Examination Fees Rs. 1000/- (Non refundable) 2.Students are required to submit the form to their Institution only. 3.If any of the statements mentioned above is incorrect, the Examination of the candidate is liable to be cancelled by the University