West Bengal University of Technology Application form for Registration

(B. Tech.-B. Pharm.-B. Arch.)

MAMB
(Application ID)

The Registrar, West Bengal University of Technology BF-142, Saltlake, Sector-1 Kolkata-700064, West Bengal
Sir, I hereby apply for registration as a student of West Bengal University of Technology. A sum of Rs. 400/- is remitted herewith as Registration Fee for the academic session 2012-2013. Necessary particulars relating to myself, given below, are true to the best of my knowledge. Place:_______________ Date: _______________ Signature of Applicant (Please Sign within the box)

Affix recent passport size photograph

Registration applied for : General Entry to 1st Semester Roll No. (if Re-Admission / Branch Change): Registration No. (if Re-Admission / Branch Change): Session Year : 2012-2013 Degree : B. Tech. Registration Against : WBJEEE Enrollment No: 3810050518 Name : Sudip Kumar Pathak Rank & Category : (WBJEEE), 16395 (GEN) College Name : JIS College of Engineering Course : B.Tech. in Electronics & Communication Engineering Applying for concession : NA

(TFW)

Sex: MALE Category: GEN Physically Challenged: N Nationality : Indian Religion : Hindu Father's Name : Sisir Kr Pathak Mother's Name : Suvra Pathak Address : 7, Seth Bagan Place, Dum Dum Junction, Kolkata PIN-700030 Phone: 9433974999 Email: sibeshmail@gmail.com Guardian's Name : Sisir Kr Pathak Address1 : 7, Seth Bagan Place, Dum Dum Junction, Kolkata Address2 : PIN-700030

Date of Birth: 9-2-1994

Name of School/College or University of which he/she was a student prior to this admission:Hindu School

Particulars of 10+2 examinations passed.
(Attested copies of all documents should be attached) Examination Higher Secondary Examination Year 2012 Board/Council W.B.C.H.S.E Marks Physics: 73.0 Chemistry: 76.0 Mathematics: 66.0 English: 72.0 Aggr(%) 77.20 Class/Divn IST

Submission Date: 2012-11-01 12:55:24

Photo Uploaded: Y

Page-1/2

........... Declaration and Undertaking by the Candidate I do hereby declare that I am fully aware of the above noted Approach of West Bengal University of Technology towards ragging and the statutory punishment to which a student shall be liable if found guilty of ragging and hereby undertake that I shall neither indulge any ragging activities nor shall take part in or subject anyone to ragging....... The University has also accepted the West Bengal Prohibition of Ragging in Educational Institutions Act...... abet.... Full Signature of the Guardian Date: ...... be willing to do or perform.... _________________________________________ Full Signature of student with date.. or causing hurt to any student or (b) asking any student to do any act..... Central Government and Others. and shall not be readmitted to that educational institution................ 2000 (W... or perform any thing............ ragging in any educational institution................ Submission Date: 2012-11-01 12:55:24 .' The Calcutta Gazette' Extraordinary....... Checked and Forwarded by __________________________________________ Signature of Director / Principal / Teacher-in-charge Name of College/Institution ____________________ __________________________________________ College Code _______________________________ Date: ______________ Place __________________ _________________________________________ Full Signature of Guardian with date Seal ________________________________ West Bengal University of Technology APPROACH OF WEST BENGAL UNIVERSITY OF TECHNOLOGY TOWARDS RAGGING West Bengal University of Technology has accepted the guidelines issued by the Hon'ble Supreme Court in connection with judgement in Civil Writ Petition No.....B..... contained the following provisions (for detail... and includes(a) testing or abusing of playing Practical joke on..... Declaration and Undertaking by the Guardian I do hereby declare that I am fully aware of the above noted Approach of West Bengal University of Technology towards ragging and the statutory punishment to which a student shall be liable if found guilty of ragging and hereby undertake that my ward shall neither indulge in any kind of ragging activities nor shall take part in or subject anyone to ragging.2000 may be seen): 1... 656 of 1998 filed by Vishwa Jagriti Mission Vs.. ...... 2..... 3.... if found guilty on enquiry by the institution against a complaint lodged by any other student.......... or propagate.. May 29.. Page-2/2 .Student Name : Sudip Kumar Pathak (Application ID : MAMB) Name of College/Institution where you have been admitted :_________________________________________________________________________________________ The particulars mentioned in page 1 of registration form are true to the best of my knowledge... (b) Imprisonment of either description upto two years or fine upto five thousand rupees or both......... (b) No person shall participate in. published by Authority on Monday.......... Full Signature of the Candidate Date: ......Penalty for Ragging (a) Expulsion from the educational Institution. The University has further accepted in principle that each and every student of the University shall be dutybound during the entire period of studentship with the University to immediately report to the authority any ragging is noticed either in University hostel or in University campus. Act XIII of 2000) which....... in the ordinary course........ or is likely to cause any physical. inter alia... I shall abide by the rules & regulations of the West Bengal University of Technology... (c) Any student convicted under 3 (b) shall be dismissed from the educational institution in which he/she has been prosecuting his/her studies for the time being..Provision of Ragging (a) Ragging within an educational institution is hereby prohibited.."Ragging" means the doing of any act which cause.... psychological or physiological harm or apprehension or shame or embarrassment to a student.. which he/she would not.