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Rajiv Gandhi Proudyogiki Vishwavidyalya

Bhopal - 462036
ENROLLMENT FORM

To,
The Registrar
Rajiv Gandhi Proudyogiki Vishwavidyalaya, Bhopal
Sir,
Giving the following details, I request you to please Enroll me in the Rajiv Gandhi Proudyogiki Vishwavidyalaya, Bhopal and also
communicate me the allotted Enrollment Number : I have read all the rules, regulations and ordinances of the university relevant to me
and I promise to abide by them. I also promise to obey all the rules and regulations enforced by the university in future.

Name MANU DIXIT Course B.Tech

Institute Code & Name 0176 Lakshmi Narain College of Technology Excellence

Branch [EC] Electronics & Communication Engineering Admission Date NA

Email ID manudixit3962@gmail.com Mobile No. 9171355256

Father's Name NARAYAN DIXIT Mother's Name MAMTA DIXIT

Gender Male Date of Birth 03/12/2004

Category UR/X Religion Hindu

Nationality INDIAN Country INDIA

KACHCHA ROAD
Aadhaar No. 5265 - 9962 - 1824 Home Address of your country PATHAK WARD
BINA

Permanent Address Kacha road pathak ward Bina

State M.P. District Sagar

Pincode 470113 Tel. No. +91

Mode of Admission CLC Marks Obtained/Out off 334.00/500

Medium of Instruction English

Class Board/University Passing Year MarkObtained/Out Off

Name of the Board/University
[10+2] CBSE 2023 334.00/500
Already Passed
Other 2021 365.00/500

Migrated From M.P. Enrollment Fee Paid to RGPV 150

Board/University Year
Name of the Board/University Migration Certificate No. (attach
0363458
last attended with Year in original)
CBSE 2023

Instructions

I. Attach all the below mentioned certificates (PhotoCopy) with your Enrollment form print out and submit in Your Institutions.
1. Counseling admission slip 2. Mark sheet of 10th & 12th(Photocopy) 3. TC(Photocopy) 4. Migration Certificate(Original). 5. Online Payment Receipt

Diploma Holders : 1. 10th Marksheet (Photocopy) 2. Diploma/B.Sc. Marksheet(Photocopy) 3. TC(Photocopy) 4. Migration (Original)