Government Engineering College, Banda

A Constituent College of Dr. A.P.J. Abdul Kalam Technical University U.P. Lucknow

ONLINE STUDENT REGISTRATION SYSTEM

APPLICATION FORM FOR REGISTRATION 2016-17

Branch B. Tech. Electrical Engineering

Semester 3
Roll No. 1573420011
Name AWANISH KUMAR MISHRA
Father's Name VINOD KUMAR MISHRA
Mother's Name NIRMALA DEVI
DOB 10/11/1997
Gender Male
Category General
Email Address AWANISHM2@GMAIL.COM
Mobile No. 9044732167
Father's/Guardian's Mobile No. 9973405355
Father's/Guardian's E-mail Address
Correspondence Address WARD NO.-24 RAGHAV NAGAR DEORIA

WARD NO.-24 RAGHAV NAGAR DEORIA

Permanent Address

Father's/Local Guardian's Address NA

Hosteler Request Yes

Sl. No DD No DD Data Bank Name Amount

1 006863 2-Aug-16 CENTRAL BANK OF INDIA 63450

2 006864 2-Aug-16 CENTRAL BANK OF INDIA 12500

Declaration:I undertake that the information submitted is true to the best of my knowledge and belief. I shall bear the
consequences if any of them are found to be wrong.
Undertaking by the Student:I will attend all the classes from the opening day of the College and I will be regular and
punctual to all the classes i.e (Theory/Practical) and I am aware that if I dont secure attendance more than 75% I shall be
detained and not allowed to appear for the Term End Examination.

Student (Seal and Signature) (Seal and Signature) (Seal and Signature)

Signature Faculty Advisor Head of Department Dean Academic

Note : You have to submit this print out to the College for validating your Registration

PRINT AS ON : 04/08/2016 PAGE 1 OF 1