ANTI-RAGGING FORM

(All departments to collect following data from the students and Mentors to complete in
the link: https://amanmovement.org/registration/public/amanmovement/Affidavit.php )

STUDENTS PERSONAL DETAILS

Last Name P
Middle Name

First Name Persis

Gender Female

Country of Origin India

State Karnataka

Mobile Number 7019168234

Students Email ID persisp1999@gmail.com

Confirm Email ID persisp1999@gmail.com

PARENT/GUARDIAN DETAIL

Parent Name Chandrashekhar P

Parent Address Shiv kumar house, shri Chaitanya techno school,
Bellary

Residence No (Not mandatory)

Parent Mobile no. 8971636270

Parent Email ID Beulahp2109@gmail.com

College Details

State in which college is based Karnataka

Is it a Professional college or General College Engineering

College Name Alva’s Institute of Engineering & Technology

Is it a deemed university No

Name of University/Board VTU

Principal Last Name Fernandes

Principal First Name Peter

Principal Gender Male
College Number (Not Mandatory)

Nearest Police Station and Address

COURSE DETAILS

Under Graduate or Post Graduate Under Graduate

Name of Course ECE

Registration/Enrolment No. 4AL17EC069

How many students are in your class

Year of Study for which you wish to register

Where you ever ragged NO

Did you ever ragged NO

What is the phone number of national anti 1800 180 5522

ragging help line
Does ragging happens at your Institute NO