(RE-REGISTRATION FORM)

Re-Registration for Semester 8

Enrollment No A4513316089
Name MS DIVYA MOHANTY
Program B.Pharm
Batch 2016-2020
Date of Birth 15/10/1997
E-Mail ID divyamohanty5@gmail.com
F 105 KUNWAR SINGH NAGAR
Contact Address
NEW DELHI(Delhi)
Pin code 110041
Phone 8447995812
Mobile 9990237482
Fax NA
Father's Name NARENDER MOHANTY
F 105 KUNWAR SINGH NAGAR
Parmanent Address
NEW DELHI(Delhi)
Pin code 110041
Phone 8447995812
Fax NA
Place of stay during this Semester (Non-Hostellers)
Address
City
Pin
Telephone
Mobile
E-mail

Date of payment of fees and fee receipt number : ______________________________ 

Are You staying in hostel ______________________________ If Yes, Room No. ______________________________
Are you having any evaluation pending for the previous semester _____________________________________________
If yes, mention the course(s) and reasons for it________________________________________________

I understand that my Re-registration for the Semester mentioned above is provisional and it will stand
cancelled in case I do not fulfill the requirements for promotion to the same as per the AUUP Regulations
(Regulation No-1 on subject Conduct of Examinations, Scheme of Evaluation and Discipline among Students in
Examinations).I also certify that I do not have any payment due to AUUP and I have met all academic
requirements till now.I shall abide by all rules and regulations of Amity University as per my undertaking in
registration form.
I have also thoroughly read and understood the Policy Guidelines for Information Security. I understand the
contents, and I agree to comply with the said Policy.I further understand that should I commit any violation of
this policy, my access privileges may be revoked and disciplinary action and / or appropriate legal action may
also be taken against me.
Date : _____________________________
(Signature of the Student)
((Name & Signature of the Verifying Faculty))