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VALLIAMMAI ENGINEERING COLLEGE

SRM NAGAR, KATTANKULATHUR – 603 203

Wi-Fi Connectivity – Registration Form for Student


Date:

Name Reg. Number


Sex Male / Female Course / Branch
E-Mail ID: Year / Section
Type of Device Laptop / Notebook
Make / Model & Serial Number
Wireless MAC Address
Ex: 04 00 2A AE &E CE
Operating System Installed and Version
Antivirus Product Installed

I hereby declare that the above information given by me is true and correct.

Signature (Student) HOD

SERVICE MANAGER
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For Office Use

IP Assigned:
Date:

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