Reg. No. ………………….

Receipt No._______Date______
Amount Rs. ________________

DELHI GLOBAL INSTITUTE OF TECHNOLOGY

MDU, ROHTAK

Examination Jan-Feb’2022

1. Name of Course & Branch: _________________________________________ Paste

Passport- size
2. Name of Candidate: _______________________________________________ Photograph
3. Father’s Name: ____________________________________________________

4. Address and Phone No. ----------------------------------------------------------------------------------------------------

___________________________________________________________________________________
_____________________________________________________________________________________

5. Subject in which the candidate wishes to appear (give subject code and name)

S.
No
. I Sem. II Sem. III Sem. IV Sem. V Sem. VI Sem. VII Sem. VIII Sem.
Subj Paper Subj Paper Subj Paper Subj Paper Subje Paper Subje Paper Subje Paper Paper
  ect Code ect Code ect Code ect Code ct Code ct Code ct Code Subject Code

1                                
2                                
3                                
4                                
5                                
6                                

I solemnly declare that I have not been debarred on account of detention in Sessional/attendance / U.M.C./
misconduct/Non-deposit of fee/ having already in ____________ (month/year)

(Signature of Candidate) (Signature of Tutor In charge)

Date ___________
(Certificate by the Principal)

Certified that ________________ is /was bonafide student of this institute.

Certified that particular given above by the candidate are correct as per official record.

(PRINCIPAL)