(RE-REGISTRATION FORM)

Re-Registration for
2
Semester
Enrollment No A50001922023
Name MR SHUBHAM TAKKAR
Program MBA
Batch 2022-2024
Date of Birth 25/01/2000
E-Mail ID shubham251takkar@gmail.com
H.NO :3398/15 SAYAD SARAI NEAR SAINI HIGH
SCHOOL , REWARI
Contact Address
REWARI(Haryana)
Pin code 123401
Phone 8607620302
Mobile 8607620302
Fax NA
Father's Name SANJAY TAKKAR
H.NO :3398/15 SAYAD SARAI NEAR SAINI HIGH SCHOOL , REWARI
Parmanent Address
REWARI(Haryana)
Pin code 123401
Phone 8607620302
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 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))