TP-175492

REGISTRATION FORM

1. Name of the Student: ________________________________

2. Father’s name : ___________________________________

3. Mother’s name : ___________________________________

4. Address : ___________________________________
____________________________________

5. Mobile No. : ___________________________________

6. Email : ___________________________________
7. Class : __________________________________
8. Semester : ___________________________________
9. College Id : ___________________________________
10. Vocational Subject: __________________________________

Student’s Signature

____________________________________________________________________________________________

Fee Deposit Details:

 Amount: Rs. 285/- only to be deposited for each semester (6 months), bank details are given as hereunder:
o Bank Name : Punjab National Bank
o Branch : HAL Township, Lucknow
o Account No. : 2414000101158193
o IFSC : PUNB0241400
 Cash receipt no/ Dated ……………………….

For Office Use only:

 UTR No. : ___________________________

 S.No : ___________________________
 Code : ___________________________
Verified by

16/3, Plot No. 4, Sarojini Naidu Marg, Near Vidhan Sabha, Lucknow-226001. Email: spreda.in@gmail.com