ਆਨ-ਲਾਈਨ ਪੀਿਖਆ ਰਿਜਸਟੇਸ਼ਨ ਫਾਰਮ

Online Examination Registration Form

(For: Regular UnderGraduate/ Postgraduate Candidate)

ਕੋਰਸ ਦੀ ਜਾਣਕਾਰੀ (ਿਜਸ ਲਈ ਤੁਸ ਅਰਜ਼ੀ ਦੇ ਰਹੇ ਹੋ ) Course Information (for which you are applying)
College/ Department Department of Electronics & Communications Engineering
Roll No.(Department/ College) 11702038 Section
Registration No 7141-17-398 Course (Semester/ Annual (Part)) B.Tech E.C.E Semester 5 Month/ Year Nov/ 2019

ਿਬਨੈ ਕਾਰ ਦੇ ਵੇਰਵੇ Applicant Details :

Application ID & Password
Applicant's Name
Date of Birth & Gender
Father's/ Guardian's/
Mother's Name
Contact Details
Correspondance Address
Permanent Address
1097734 Password: PR7AE31C
MAYANK SHARMA( ਮਯੰਕ ਸ਼ਰਮਾ )
25-1-1998 Gender: Male
KESHAV DEV SHARMA( ਕੇਸ਼ਵ ਦੇਵ ਸ਼ਰਮਾ )/ SANGEETA SHARMA( ਸੰਗੀਤਾ
ਸ਼ਰਮਾ )
8171402988     7087800663          yesbhardwaj1@gmail.com 
10 Others Uttar Pradesh 203001
10 BULANDSHAHR Uttar Pradesh 203001

ਅਿਤਿਰਕਤ ਕੈਟੇਗਰੀ ਦੀ ਜਾਣਕਾਰੀ Additional Category Information

Category General Single Girl Child (Punjab) Category No
Blind Category No Physically Handicaped Category No
Cancer/Aids and Thalassemia Category No Outstanding Sports Person (All India) Category No

ਪੀਿਖਆ ਨਾਲ ਸੰਬੰਧਤ ਜਾਣਕਾਰੀ Examination Related Information:

Are you appearing in Two Examination? No Details of Second Examination (if applicable) -
Medium of Examination English
Have you ever been disqualified? Details (if Have you applied for re-evaluation of lower examination? Details
applicable) (if applicable)

ਵਧੀਕ ਜਾਣਕਾਰੀ Additional Information:

Aadhar No. / NAD ID 681352799941 / Postmatric Scholarship No
Religion Hindu Area Urban

I have gone through the Syllabus, Ordinances and Statutes of this examination and understood the same for my eligibility
for the examination. In case of any discrepancy found in the particulars filled in by me in this Form, I shall be responsible
for the consequences. I agree to the fact that all the disputes arising from the documents or information connected
therewith are subject to territorial jurisdiction of Courts situated at Patiala only to the execution of all other Courts. I
understand that if my result of this class is declared RESULT LATER, R.L. (FEE/EE/REGISTRATION etc.) in the main
Gazette by the University due to non-clearance of fee/fine or non-submission of original documents for eligibility well in
time by me and afterward, completion of deficiency by me, the result is properly declared detailed marks card sent by the
University, then at that time I will have no right of re-checking re-evaluation or getting photocopy of Answer sheet.In case
of any discrepancy on my part, I will get the benefits of these facilities on the basis of dispatch of provisional intimation
at the time of declaration of main result by the University.I have gone through the Important Information & Instructions as
lay down in this admission form.

(Signature of Candidate)