DEENBANDHU CHHOTU RAM UNIVERSITY OF SCIENCE AND TECHNOLOGY

MURTHAL – 131 039 (SONEPAT)

(Established Under Haryana Legislature Act. No. 29 of 2006)

PERFORMA FOR IDENTITY-CUM-LIBRARY CARD (STUDENT)

Note: - All the entries should be filled in capital letters and in own handwriting. Incomplete Performa
will be rejected.

1. Name (in Capital Letters) :____________________________________________

2. Father’s Name :____________________________________________

3. Roll No. Paste

:____________________________________________
Recent
Photograph
4. Department :____________________________________________

5. UG / PG/ Research Scholar : ____________________________________________

6. Duration of Course :_____________________ to ___________________________

7. Class and Year : __________________________________________________

8. Regular/Weekend :__________________________________________________

9. Permanent Address :__________________________________________________

and Contact No. ___________________________________________________

___________________________________________________

10. E-mail ID :__________________________________________________

11. Blood Group :__________________________________________________

It is certified that all entries have been filled by me and correct.

Student Signature

Chairman of the Department (with Stamp) Specimen full Signature of Student

University Librarian

For Library use only:

1. Validity of Identity-cum-Library Card: ___________________________________