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Government Of Rajasthan

Board of Technical Education , Rajasthan


Engineering Examination Form - 2021-22 (Special)
College Name: SS POLYTECHNIC COLLEGE, UDAIPUR Roll No.:
Branch: ELECTRICAL ENGINEERING
Student's Name: BRIJ BIHARI Enrollment No.: EE20180027/214
Father's Name: SANJAY KUMAR
Mother's Name: CHOTU DEVI
Student's Hindi Name: ज बहार
Father's Hindi Name: संजय कुमार
Mother's Hindi Name: छोटू देवी
Category: GEN
Date Of Birth: 23/12/2003
Mobile: 7004175171
Aadhar: 479233862788 Photo Should be attested by H.O.D.
Email: Brijbihari085@gmail.com
User Name: 201703

Subject(s) to be offered for Examination Regular or Ex


Year Student Type Paper Details Fee Details
Third Year EX 304T 300.00
I declare that
All details furnished above are correct. I am not appearing for any other Examination and there was / is no UFM
registered against me.
Signature of Student
Examination Form has been checked by me and student is eligible to appear in this Examination as per rules.

Seal & Signature of H.O.D. Seal & Signature of Principal


To Be Filled by the Institution To be filled in Examination Hall Only
Deposited Rs. Student's Signature
Emitra Transaction ID
Payment Date Signature is Verified

Cashier Supdt. /Addl. Supdt

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