8/8/2019 Dean Academic Form

MOTILAL NEHRU NATIONAL INSTITUTE OF TECHNOLOGY, Please,

ALLAHABAD paste
your phot
Here

FORM FOR ENROLLMENT &

ACADEMIC REGISTRATION FOR FIRST SEMESTER
REGISTRATION NO : 2019FE19

NAME OF THE CANDIDATE : ASHUTOSH DWIVEDI

DATE OF BIRTH : 1996-06-01

GENDER : MALE

PHYSICALLY HANDICAPPED : NO

BLOOD GROUP : --

NATIONALITY : INDIAN

PROGRAMME ADMITTED TO : Master of Technology

YEAR OF ADMISSION : 2019

TYPE OF ACCOMODATION : Hosteller

NAME OF FATHER : umashankar dwivedi

FATHER' CONTACT NO : 9893901110

FATHER's OCCUPATION : medicine seller

FAMILY INCOME : 0.5 Lacs per annum

mig 91 housing board colony

utaily
RESIDENTIAL ADDRESS :
satna-485001.
MADHYA PRADESH

LOCAL GUARDIAN NAME :

LOCAL GUARDIAN ADDRESS :

-.
UTTAR PRADESH

LOCAL GUARDIAN CONTACT NO : 7693960085

STATE OF ELIGIBILITY
(FOR FOREIGN STUDENTS GIVE zz
COUNTRY NAME) :

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8/8/2019 Dean Academic Form
NA ( 'or' Sponsoring Ministry for Students of Foreign
JEE MAINS RANK : Nationals )

ALLOTED CATEGORY OR SCHEME

(DASA/ICCR/SAARC FOR FOREIGN OP
STUDENTS) :

APPLIED CATEGORY OR SCHEME

(DASA/ICCR/SAARC FOR FOREIGN
STUDENTS) :

FOLLOWING DETAILS TO BE FILLED MANUALY

DETAILS OF QUALIFYING EXAM :

LIST OF ORIGINAL DOCUMENTS

SUBMITTED :
1. 4.
2. 5.
3. 6.

DECLARATION BY THE STUDENT

I solemnly declare that all the statements made in this proforma are true to the best of my
knowledge. I promise to abide by the Institute rules & regulations in force from time to time.

DATE : SIGNATURE OF THE STUDENT

FOR OFFICE USE ONLY

PROGRAMME ADMITTED TO :

BRANCH :

GROUP (FOR B.Tech. ONLY) :

DATE : SIGNATURE OF THE OFFICER

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8/8/2019 Dean Academic Form

MOTILAL NEHRU NATIONAL INSTITUTE OF Please,

TECHNOLOGY paste
ALLAHABAD your photo
Here

LIBRARY MEMBERSHIP REGISTRATION FORM.

REGISTRATION NO : 2019FE19

NAME OF THE CANDIDATE : ASHUTOSH DWIVEDI

TYPE OF ACCOMODATION : Hosteller

Mobile No. : 7693960085

Parent's/Guardian's Phone No.: 9893901110

E-mail ID: ashutoshpavan97@gmail.com

mig 91 housing board colony

utaily
RESIDENTIAL ADDRESS :
satna-485001.
MADHYA PRADESH

PROGRAMME ADMITTED TO : Master of Technology

CANDIDATE CATEGORY OR SCHEME

(DASA/ICCR/SAARC FOR FOREIGN OP
STUDENTS) :

BRANCH : Fluids Engineering

YEAR OF ADMISSION : 2019

DATE OF BIRTH : 1996-06-01

BLOOD GROUP : --

GENDER : MALE

DECLARATION BY THE STUDENT

I solemnly declare that all the statements made in this proforma are true to the best of my
knowledge. I promise to abide by the Institute rules & regulations in force from time to time.

DATE : SIGNATURE OF THE STUDENT

TO BE FILLED BY THE BORROWER AT THE TIME OF NO DUES.

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8/8/2019 Dean Academic Form

HOSTEL DATE OF
SESSION CLASS BRANCH DUES,IF ANY REMARK
& ROOM NO. SURRENDER
GENERAL TLB

SIGNATURE OF LIBRARY STAFF SIGNATURE OF THE STUDENT

SIGNATURE OF LIBRARIAN DATE :

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8/8/2019 Dean Academic Form

MOTILAL NEHRU NATIONAL INSTITUTE OF Please,

TECHNOLOGY paste
ALLAHABAD your photo
Here

DEAN STUDENT WELFARE FORM.

REGISTRATION NO : 2019FE19

NAME OF THE CANDIDATE : ASHUTOSH DWIVEDI

BLOOD GROUP : --

DATE OF BIRTH : 1996-06-01

PROGRAMME ADMITTED TO : Master of Technology

BRANCH : Fluids Engineering

NATIONALITY : INDIAN

YEAR OF ADMISSION : 2019

TYPE OF ACCOMODATION : Hosteller

NAME OF FATHER : umashankar dwivedi

FATHER' CONTACT NO : 9893901110

mig 91 housing board colony

RESIDENTIAL ADDRESS : utaily
satna-485001.
MADHYA PRADESH

FATHER's INCOME : 0.5 Lacs per annum

LOCAL GUARDIAN NAME :

LOCAL GUARDIAN ADDRESS :

-.
UTTAR PRADESH

LOCAL GUARDIAN CONTACT NO : 7693960085

STATE OF ELIGIBILITY
(FOR FOREIGN STUDENTS GIVE MADHYA PRADESH
COUNTRY NAME) :

JEE MAINS RANK : NA ( 'or' Sponsoring Ministry for Foreign Students )

ALLOTED CATEGORY OR SCHEME

(DASA/ICCR/SAARC FOR FOREIGN OP
STUDENTS) :

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8/8/2019 Dean Academic Form
APPLIED CATEGORY OR SCHEME
(DASA/ICCR/SAARC FOR FOREIGN
STUDENTS) :

FOLLOWING DETAILS TO BE FILLED MANUALY

DETAILS OF QUALIFYING EXAM :

DECLARATION BY THE STUDENT

I solemnly declare that all the statements made in this proforma are true to the best of
my knowledge. I promise to abide by the Institute rules & regulations in force from time
to time.

DATE : SIGNATURE OF THE STUDENT

FOR OFFICE USE ONLY

PROGRAMME ADMITTED TO :

BRANCH :

GROUP (FOR B.Tech. ONLY) :

DATE : SIGNATURE OF THE OFFICER

https://academics.mnnit.ac.in/fresh_reg/validate_frm.php 6/6