PEC University of Technology, Chandigarh

STUDENT CARD APPLICATION FORM

(TO BE FILLED IN CAPITAL LETTERS ONLY)

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NAME:
FATHERS
NAME:
BRANCH:
STUDENT
ID NO.:
ADDRESS:

MOBILE
NO. (SELF):
MOBILE
NO.(Parents/
Gaurdian):
BLOOD
GROUP:
VALID
UPTO:

FROM:

To:

1. I hereby solemnly affirm and declare that the entries made by me in this form are true and
correct to the best of my knowledge and no information has been concealed in any manner.
2. I understand that if at any stage it is found that I have provided any wrong information or have
suppressed any information, disciplinary action can be taken against me by the authorities.
Signature of Student
Verified that the particulars given by the students in the ID Card Application Form i.e.
Name, Fathers Name, Branch, SID and address are correct as per the personal file of student
maintained in the office of Dean Academic Affairs.

Verifying Officer,
Office of Dean Academic Affairs
NOTE: The complete and verified ID application form may be submitted in the DSA office after the
last round of counseling