Annexure 4

Name (As per 10 th

Mark Sheet):

Application Number: Emergency Contact

No.: Photograph
Width: 275 pixels
Blood-Group:
Emergency Contact No.: Blood-Group:
Width: 275 310
Height: pixelpixels
Resolution: 300

Student Signature:

Communication Address

Permanent Address

Student Identity Card Requisition Form

FOR OFFICE USE ONLY

Student Roll Number:

Forwarded By Approved By

Manager - Admissions General Manager - Resource Centre

IDENTITY CARD RECEIVER'S STATEMENT

I have received the identity card on:

Card Issued by:

Student Signature:
(RC Staff Sign)