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Registration Form
Odd Semester (July 2016-December 2016)
Date of Registration

______________________________

Name of Student

______________________________

Fathers Name

______________________ Occupation:________________

Mothers Name

______________________ Occupation:________________

Course (Tick)

BTech(CSE)/BTech(IT) /BTech(CSE-CC)/BTech(CSE-BDA)

Semester (Tick)

3rd/5th/7thDate of Birth (dd/mm/yy)

: _______________

Batch

______________________________

E-Mail ID

______________________________

Mobile No.

Self No: +91______________Parents No: +91___________

Section

A/B/C/D/CC/BDA Class Roll No:_____________

University Roll no

______________________________

Enrolment No.

______________________________

Fee Receipt No.

______________________________

Complete Address
(Permanent)

______________________________
______________________________

Complete Address
(Local)

______________________________
______________________________
Signature of Student
For Department Use Only

Date of Registration

Fee Receipt copy attached

Yes

Late Fee Receipt copy attached

Yes

No (Tick)
No (Tick)
(If yes Receipt No

Name &Signature of Class Coordinator

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