INTEGRATED ACADEMY OF MANAGEMENT AND TECHNOLOGY,Ghaziabad

STUDENT REGISTRATION FORM

(Provisional: Subject to clearance of dues and as per academic/administrative rules)
Reference ID: 281201521566
Course and Session: PGDM/ 2013-2015 (PGDM only)

Date: 28-1-2015

Roll No: PG-13-017

Roll No.(University):

Name:

Semester/Trimester: VI

MANAS KUMAR DASH

Time: 21:56:6
PG-13-017

Fathers Name:

DIPAK KUMAR DASH

Mothers Name:

UJJWALA DASH

Mobile No.(Father):

9800094579

Mobile No. (Candidate): 8506949362

Present Address: SIDHARTH BOYS HOSTEL, AKASH

NAGAR, INDER GARHI, GHAZIABAD, UP

Permanent Address: VILL- SINDURIA, PO- SHIPUR,

PS- EGRA

Tehsil/District: GHAZIABAD

Tehsil/District: PURBA MEDINIPUR

Pincode:

201009

Pincode:

721448

Date of Birth:

1-1-1991

Email:

manas.ds2013@gmail.com

AFFIX YOUR PHOTOGRAPH HERE

I, solemnly affirm that:

1. The above-mentioned details are correct. In future if there is any change in above details, I will update the
concerned authorities myself without delay.
2. I will achieve minimum 75% attendance throughout the Semester to appear in the examination.
3. I will not use mobile phone inside class room/ seminar hall/ committee room , in case I am found using mobile
it may be seized by the concerned authorities and disciplinary action can be initiated against me.
4. I will carry & wear my Identity card inside the campus at all times; in case I fail I may not be allowed to enter
the campus.
5. Security of Laptops, mobile phone, books, ID-cards and other personal valuable items will solely lie on me. (both at
campus and hostels)
6. I am fully aware that I have to vacate the hostel by 31st May 2015 and in case I want to continue to avail the hostel
facility for next session , I will submit a written request to the hostel warden by 2nd April 2015.
7. I will wear Uniform on prescribed days and whenever asked for, in case I fail I may not be allowed to enter the
campus or a fine may be imposed.
8. I will read the notices/circulars placed on the notice board and uploaded on the CMS to get the updates related to
Fee payment scheduled, rules and guidelines etc.
9. I will be solely responsible for renewal of re-examination Marksheet from university.

Candidate

Program Coordinator

:https://plus.google.com/+InmantecEdu1995

Registrar
:www.facebook.com/inmantec