MICROTEK COLLEGE OF

MANAGEMENT AND TECHNOLOGY

(Associate Study Center of Punjab technical University, Jalandhar)
Centre Code:-_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Nirmal Complex, Maldahiya, Varanasi- 221001

SCHOLARS REGISTER AND TRANSFER CERTIFICATE

FORM

ENROLMENT NO. :...................... TRANSFER CERTIFICATE NUMBER

1. ADMISSION NO :..

.
2. SCHOLARS NAME : ..
3. MOTHERS NAME :

...
4. FATHERS NAME :.

..
5. ADDRESS :..

.
6. GURADIANS NAME :...
7. TELEPHONE : RESI OFF. .....
8. DATE OF BIRTH : DATEMONTHYEAR..

...
9. SC / ST / OBC :SEX (M / F )...
10. NATIONALITY :RELIGION: .....
11. NAME OF THE SCHOOL LAST ATTENDED :

12. T. C. SUBMITTED :BIRTH CERTIFICATE SUBMITTED .

CLASS DATE OF DATE OF DATE OF CAUSE OF YEAR CONDUCT AND

ADMISSION PROMOTION REMOVAL REMOVAL WORK

Certified that the above Scholars register has been posted upto date as required by the
Department rules.

HEAD OF THE
INSTITUTION
Signature of the Father or Guardian receiving the T.C.
SEAL

..........