PERSONAL INFORMATION

DATE OF ISSUE : 2020-01-17 STATUS :

ROLL NO : 1900290130138 COURSE: B.TECH SEM: 2 SEC: C

NAME : SACHIN KUMAR GUPTA SUDENT'S MOBILE : 9794912138

FATHER'S NAME : Mr. SURENDRA KUMAR GUPTA FATHER'S MOBILE : 9026333865

SUDENT'S EMAIL ID : PHYISCAL HANDICAPPED : NO

SACHINGUPTA959@GMAIL.COM

CATEGORY : OBC(NCL) RELIGION : HINDU

BANK DETAILS

ACCOUNT NAME : SURENDER KR. GUPTA ACCOUNT NUMBER : 28660100004338

IFSC CODE : BARB0SHIVBS BANK NAME : Bank of Baroda

ADDRESS:S-29/406-B,SHIVPUR,VARANASI- BRANCH : SHIVPUR, VARANASI

221003,U.P,UTTAR PRADESH

STUDENT INSURANCE

NOMINEE : FATHER NOMINEE'S NAME :

SURENDRA KUMAR GUPTA

PARENT'S INSURANCE

INSURER : FATHER INSURER'S NAME :

SURENDRA KUMAR GUPTA

INSURER'S AADHAR NO. : 900396248295 INSURER'S DATE OF BIRTH : 1958-07-10

INSURER'S OCCUPATION. : BUSINESS INSURER'S NOMINEE : SHASHI GUPTA

INTERNSHIP DETAIL

INTERNSHIP INTEREST : Projects in the Departments/Inter-Department

I need the assistance from Internship and Industry Partnership Cell (IIPC)

STUDENT SIGNATURE
(For use by the class Co-ordinator)
CERTIFIED THAT FOREGOING DETAILS HAVE BEEN CHECKED BY ME. HE/SHE IS ALLOWED / NOT ALLOWED TO REGISTER.

DATE SIGNATURE OF CO-ORDINATOR/HEAD OF DEPT

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(Acknowledgement Slip: For Student)
ROLL NO/LIBRARY ID : 1900290130138 NAME : SACHIN KUMAR GUPTA
THE HOLDER OF THIS SLIP IS ALLOWED TO REGISTER IN THE COURSE / BRANCH MENTIONED BELOW :