Abhishek Kumar - 2021-02-23 - 09 - 27 - 13

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Himachal Pradesh Technical University

Campus at Daruhi Tehsil and District Hamirpur HP


Form of Application for Registration as Student of the University Academic Session 2020-2021
(All Entries Should be filled By the Candidate
Registration fee : Rs. 1500/- per candidate)

1) Name of The Student (In Block Letters ) : ABHISHEK KUMAR (In Hindi) :

Note : Name & Fathers Name entered in this form should tally excatly with the Matriculation or equivallent
Examination Certificate or in the Migration Certificate issued by the other University / Board .

2) Name of the Father (In Block Letters) : Baryam singh bhardwaj (In Hindi) :

3) Name of the Mother (In Block Letters) : Neelam kumari (In Hindi) :

4) Date of Birth of the Student (dd/mm/yyyy) : 26 Nov, 1997

5) Contact Number : 8580626795 Email : mrabhishekbhardwaj16@gmail.com

6) Aadhar No : 974596662028 Gender : Male

7) Category : General Sub-Category : Other

8) Qualifying Exam Passed : H.S.C.(Science)

9) Board / University : Himachal Pradesh School Education Board

10) Year of passing the exam : 2016 under Roll No : 1642473 % of Marks : 91.8

11) College / Institution joined : Atal Bihari Vajpayee Government Institute of Engineering and Technology
Pragatinagar,District Shimla,(HP)

12) Course in which joined : Bachelor of Technology in Computer Science and Engineering Branch / Stream :
________

13) Date / Month of joining : ___________

14) Permanent Address :V.p.o serathana Kangra


Pin Code :176056

15) Address for Corresspondance :V.p.o serathana Kangra


Pin Code :176056

List Of Documents :

1) Matriculate certificate .

2) 10+2/Diploma/ Graduation/ Other certificate.

3) Affidavit for gap (if any) .

4) Entrance Test Score Card (if any) .

5) Bonified Himachal/Domicile .

6) Latest Character Certificate .

7) Migration Certificate .

8) Sub category certificates (Tuition Fee waiver/Physical Challenged/Kashmiri Migrant/


Beti Hai Anmol/Defence/ IRDP/BPL /Ward of Ex-serviceman /Freedom Fighters/ EWS/
Other /Antodya/Orphan/Backward Area .

Signature of Student
CERTIFICATE

I certify that the above named candidate is not registred in Himachal Pradesh Technical University earlier and has filled the form
himself / herself . The fee of Rs._______(along with original Migration Cerificate in case of candidate migrating from other
University/Board forwarded herewith ). He/She is regular student of this college .

Dated :-_________ Principal


(Signature with seal)

Note : -1) Registration alone doesn't entiate a candidte to appear at a University Examination .
2) At the Time of Migration to other University/Board/Institution original Regis. Card be submitted .

(For Office Use Only)

Fees Rs. : ___________________ (Rupees_____________________________________________________ )

Received and Entered Against NO _______________________________________________

Registration No : ___________________ Finance Officer

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