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(RE-REGISTRATION FORM)

Re-Registration for Semester Name Program E-Mail ID Contact Address

Enrollment No.

A7605109092

MR ANOOP NEGI B.Tech (E&CE) Batch 2009-2013 Date of Birth 08/09/1989

anup20negi@gmail.com S/O SURENDRA SINGH NEGI, VINOD VIHAR COLONY, KHADRI ROAD, SHYAMPUR, P.O.SATYANARAYAN, MANDIR viram khand RISHIKESH, DEHRADUN(Uttaranchal) 249204 Phone 01352451723 Mobil e 954894852 0 Fax 0

Pin code Father's Name Parmanent Address

SURENDRA SINGH NEGI S/O SURENDRA SINGH NEGI, VINOD VIHAR COLONY, KHADRI ROAD, SHYAMPUR, P.O.SATYANARAYAN, MANDIR vinod vihar calony rishikesh RISHIKESH, DEHRADUN(Uttaranchal) 249204 Phone 01352451723 Fax 0

Pin code

Place of stay during this Semester (NonHostellers)

With Parent Address City Pin Telephone e-mail

rdian

Gua

Own Arrangement

3/326 VIBHAV KHAND GOMTI NAGAR LUCKNOW 226010 NA NA Mobil e 904447487 9

Date of payment of fees and fee receipt number : ______________________________ Please attach fee receipt. 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 to AUUP and I have met all academic deadlines till now

Date : _____________________________

(Signature of the Student)

(Name & Signature of the Verifying Faculty