(RE-REGISTRATION FORM)

Re-Registration for
2
Semester
Enrollment No A21704823076
Name MR LUCKY BHAWARIYA
Program BCA
Batch 2023-2026
Date of Birth 05/12/2004
E-Mail ID luckyjat2233@gmail.com
WARD NO. 10 PACHLANGI VILLAGE
Contact Address
UDAIPURWATI(Rajasthan)
Pin code 333801
Phone 8920474333
Mobile NA
Fax NA
Father's Name MUKESH KUMAR
WARD NO. 10 PACHLANGI VILLAGE
Parmanent Address
UDAIPURWATI(Rajasthan)
Pin code 333801
Phone 8920474333
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))