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FART FIAT TTI SUbusue ob (fo io 20 feed) aRrsr ere see selMMMUT, GORAKHPUR ‘Semester Fee Deposite Challan (Power Jyoti Scheme) Collection Branch Copy © MMMUT, GORAKHPUR Semester Fee Deposite Challan (Power Jyoti Scheme) Collection Branch Copy MMMUT, GORAKHPUR ‘Semester Fee Deposite Challan (Power Jyoti Scheme) Collection Branch Copy State Bank of India ‘Branch State Bank of India Branch ‘State Bank of India ‘Branch Account No: 31580851255 Account No: 31580851255 Account No: 31580851255 “MMMUT Fee Account” “MMMUT Fee Account” “MMMUT Fee Account” SBI, MMMUT, Gorakhpur Process through Power Jyoti Scheme SBI, MMMUT, Gorakhpur Process through Power Jyoti Scheme SBI, MMMUT, Gorakhpur Process through Power Jyoti Scheme MIS-L ‘MIS-1 MIS-L Reg No*: Reg Not: Reg No*: Roll No Roll No Roll No ‘Name: ‘Name: ‘Name: ‘Course: Course ‘Course: Branch Branch: Branch: ‘Semester Semester ‘Semester Particulars In Rupees Particulars In Rupees Particulars In Rupees, Institue Fee Hostley institute Fee (Hosteer) Insitute Fee (Hostele Institute Fee( Day Scholar) Institute Fee( Day Seholan Institute Fee( Day Scholar ‘Total Amount: Total Amount: Total Amount: Total amount Total amount “Total amount (in words) (in words) (in words) Date Date Date Bank Charge of Rupees70/- only to be collected ‘Bank Charge of Rupees70- only to be collected Bank Charge of Rupees70/- only to be collected upfront by the Branch, upfront by the Branch. upfront by the Branch, Name of the ‘Name of the Name of the Romitter: Remiter: Romitter: Address: Address: Address: ‘Contact No: Contact No. ‘Contact No: Sign of Remitter: Sign of Remitter: Sign of Remitter: Journal No: Tournal No, Journal No: Rectvd th amount sper dis mentions above Signature of Receiver & Bank Acknowledgement Stamp Resid the amount as per details mentioned above Signature of Receiver 4 Bank Acknowledgement Stamp Rectvd th amount sper dels mentionsd above Signature of Receiver & Bank Acknowledgement StampMadan Mohan Malaviya University of Technology Gorakhpur ~ 273010 (U.P.) India (Formerly : Madan Mohan Malaviya Engineering College, Gorakhpur) Established by Act no, 22 of 2013 of UP. Govt. ‘Telephone No.: 8765783704 Website : www.mmmut.ac.in ‘Academic Registration Form, Odd Semester Session 2019 - 20 Name Registration No. Sse Course Branch Sem. (Year) Date of Birth ‘Admission Test Roll No. General Rank Category Gender a Religion Mosteler/Day Scholar Blood Group Medical History, if any Student Mobile No, E-mail Father's Name Mother Name Land Line No. Mobile Father's E-mail Permanent Address Revregistered Subjects | Current Semester Selected Subjecte 1 Details of Local Guardian, if any e (ame, address and phove no.) ecaration by Student: Itis to cery that all my information/dtals furnished by me in this registration form and for this admission are correc. In case of any Jnformation given by me being found incorrect at any stage, the Universty reserves the right to cancel my admission, I also undertake tot Tear ace spss myelin any ac of again, smoking, use of iquor, misconduct, strikes damage tothe Universty assets and other proloted aces Grieg te ‘study in the University falling which Univesity may cancel my admission and take necessary action Thal not be undertaking any employment uniess permitted by University and shall abide by the respective Crdinance and orders of the University as enforced from time to time, Forwarded for registration Left hand Thumb Impression Signature of the Student Signature of HOD/faculty Scholarship Details ‘Semester/ Year Fee Details Hostel Details, ‘Any Scholarship Received Rs. — Challan /00 No. : ‘Name of the Hoste! Fee Reimbursement Rs. ~ oa ean Bank: Mess Fee Details ‘Amount Sig. & Seal of Scholarship Official Sig. & Seal of Account Official ‘Sig. & Seal of Hostel Official Signature of Dean (Student Affairs) ‘Signature of Dean (UGS8E) / Dean (PGS and R&D) ACKNOWLEDEMENT SLIP Mr./Ms. Registration No. ‘Sem.(Year) Course Branch Hostel Name Has been provisionally registered on ‘Current Semester Selected Subjects Re-registered Subjects, fh 2 ‘Signature of Dean (Student Affairs) ‘Signature of Dean (UGS&E) / Dean (PGS and R&D)