JAWAHARLAL NEHRU TECHNOLOGICAL UNIVERSITY HYDERABAD

JNTUH UNIVERSITY COLLEGE OF ENGINEERING MANTHANI (JNTUH UCEM)

(A constituent college of JNTUH - Hyderabad & Approved by AICTE, New Delhi) (Recognised by UGC under section 2(f)
& 12(B) of UGC Act 1956)
COURSE REGISTRATION FORM
HALL TICKET NO.& YEAR OF ADMISSION & COURSE IN
1. :
WHICH ADMITTED 22VD5A2506 & 2022-23 & B.Tech - Mining engineering
2. :
NAME OF THE STUDENT AKKALA RATHIN
3. :
MOBILE NUMBER OF STUDENT 9347072162
4. :
EMAIL ID (STUDENT) rathinakkala@gmail.com
5. :
GENDER M
6. :
AADHAR NUMBER 315599179554
7. :
DATE OF BIRTH 09-09-2002
8. :
PLACE OF BIRTH Ippalapally,Jayashankar Bhupalpally,Telangana

IDENTIFICATION MARKS
9. : 1.A mole on lip
2. A mole on left hand little finger
10. :
BLOOD GROUP A-ve
11. :
NATIONALITY & RELIGION Indian & Hindu
12. :
CATEGORY OF CASTE BC-D SUB-CASTE : Yadava CND022223584340
: AKKALA BAPU AKKALA LAXMI
Name
Mobile : 7416046144 7801072162
13. PARENT DETAILS : Email : nania9454@gmail.comrathinyadav950@gmail.com
Aadhar No : 343651660776 531484590059
Occupation : Farmer Farmer
Income : Up to 1 Lakh Up to 1 Lakh
14. :
DATE OF COUNSELLING 10-09-2022
15. :
EAMCET / ECET HT NO. 8525061501 RANK : 1204
16. :
DATE OF ADMISSION IN THE COLLEGE 01-10-2022
17. :
CATEGORY OF ADMISSION E-CET Admission Type : General
18. PERMANENT ADDRESS :
Malhar rao,Jayashankar,Telangana,Jayashankar Bhupalapally-505503,India
19. ADDRESS FOR CORRESPONDENCE :
Malhar rao,Jayashankar,Telangana,Jayashankar Bhupalapally,-505503,India
20. :
ARE YOU PHYSICALLY CHALLENGED NO
21. :
HEALTH COMPLICATIONS, IF ANY
22. :
ARE YOU INTERESTED IN Debates,Drama,Sports
WOULD YOU LIKE TO JOIN ANY OF THE ABOVE CLUBS IN THE
23. :
COLLEGE Yes
24. :
IF HOSTELLER, LOCAL GUARDIAN'S ADDRESS Malhar rao,Jayashankar,Telangana,Jayashankar Bhupalapally-505503,India
25.
ARE YOU ELIGIBLE FOR ANY SCHOLARSHIP IF YES, MENTION THE TYPE OF SCHOLARSHIP: Yes BC
26.
TUTION FEE PARTICULARS : Exempted

Signature
AKKALA RATHIN AKKALA BAPU AKKALA LAXMI
DECLARATION BY THE CANDIDATE
I declare that I shall submit ALL THE CERTIFICATES, which are due from me in original within one week from the date of admission in the college, falling which, I
am fully aware that my admission in the college stands cancelled. I assure you that I will not participate in any ragging now & in future. I am aware of the
consequences of getting involved in any ragging incident.

Candidate's Signature
Parent's / Guardian's Signature

Date :

For Office purpose only

The candidate is admitted in B.Tech - MINING ENGINEERING His / Her Roll No.is ________________________

DEPUTY REGISTRAR PRINCIPAL