(RE-REGISTRATION FORM)

Re-Registration for
2
Semester
Enrollment No A20405222150
Name MR PRIYANSHU DHAMA
Program B.Tech (CSE)
Batch 2022-2026
Date of Birth 30/10/2004
E-Mail ID priyanshudhama48@gmail.com
KHEKRA BAGHPAT,U.P PATTI MUNDALA
Contact Address
BAGHPAT(Uttar Pradesh)
Pin code 250101
Phone 8077182340
Mobile 8077182340
Fax NA
Father's Name SURESHPAL SINGH
KHEKRA BAGHPAT,U.P PATTI MUNDALA
Parmanent Address
BAGHPAT(Uttar Pradesh)
Pin code 250101
Phone 8077182340
Fax NA
Place of stay during this Semester (Non-Hostellers)
Address
City
Pin
Telephone
Mobile
E-mail
Hobby Club N/A

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 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 academic regulation.I also certify that I do not have any payment of dues and I
have met all academic deadlines till now
Date : _____________________________
(Signature of the Student)
((Name & Signature of the Verifying Faculty))