(RE-REGISTRATION FORM)
Re-Registration
for Semester
Enrollment No
Name
Program
Batch
Date of Birth
E-Mail ID
5
A20405220001
MR AMAN TOMAR
B.Tech (CSE)
2020-2024
27/02/2001
Amantomarekking@gmail.com
H. No 56 kailashpuram govindpuram ghaziabad
Contact Address
Pin code
Phone
Mobile
Fax
Father's Name
Parmanent
Address
Ghaziabad (Uttar Pradesh)
201001
9625280935
NA
NA
RAKESH TOMAR
10,NEAR CHAMUNDA MANDIR, AHAR GATE,ANUJSHAHER 10,NEAR
CHAMUNDA MANDIR, AHAR GATE,ANUPSHAHER
BULANDSHAHR(Uttar Pradesh)
Pin code
202390
Phone
9625280935
Fax
NA
Place of stay during this Semester (Non-Hostellers)
Address
City
Pin
Telephone
Mobile
E-mail
Hobby Club
N/A
Date of payment of fees and fee receipt number : ______________________________
Are You staying in hostel ______________________________ If Yes, Room
No. ______________________________
Are you having any evaluation pending for the previous semester
_____________________________________________
If yes, mention the course(s) and reasons for
it________________________________________________
I understand that my registration for the Semester mentioned above is provisional and it
will stand cancelled in case I do not fulfill the requirements for promotion to the same as
per the academic regulation.I also certify that I do not have any payment of dues and I
have met all academic deadlines till now
Date : _____________________________
(Signature of the Student)
((Name & Signature of the Verifying Faculty))