Panjab University, Chandigarh

Application form for Network User Registration

Department of Economics

Office Diary No: _____________________

Date: ________________________

Application No. 168419

User Type * Research Scholar
Registration No./PUPIN * 1234567890
Name of Applicant * TARUN GOTHWAL
Class/Course * M.PHIL 1st Year
E-mail ID gothwalansh@gmail.com
Mobile No. 7611038413
MAC Address(es) 04:c8:07:b6:1f:c7
Hostel * Hostel (Boys) 3
Block No./Room No. 2/56
Login ID 168419
Registration Date 21st October, 2019

I certify that Laptop/Desktop having above MAC address(es) belongs to me. I will be responsible for the
activities performed against user name and password assigned to me and will not share this information
with others.I do not have any other valid network user account of PU. I am aware of my responsibility
towards the use of Internet under IT Act 2000 and its amendments and IT policy of PU.

I have attached the photocopy of my ID Card for necessary action.

(Signature of Applicant)

(*) Verified by Office

(Name of Official who verified the record)

Signature and Stamp

Chairperson/Head

Application form for Network User Registration- Page 1/1

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