Web Form No.000002                                                                          
ONLY FOR BE (TELECOMM) STUDENTS FOR IDENTIFIED REMEDIAL EDUCATIONAL COURSES

FOR OFFICE USE BATCH       SR         RT PROGRAMME: ____________     SEMESTER: ____________

1.    Registration No.     -       -         Roll No.

2. Please narrate the courses along with course code which you intend to take in this semester:

(Tick in the relevant block)

3. Name:

Mr. Ms.

                                     (NAME IN CAPITAL LETTERS)

4. Father's Name:

                                     (CAPITAL LETTERS)

5. Fee deposited Rs: ____________ (Rupees ____________________________________________________only)

Vide Bank Challan No._____________ Dated: _____________ Bank Branch ______________________________
        Note: Please attach the original copy of Challan Form Copy No # 1.

6. Mailing Address (If wants to change otherwise no need to mention)  ________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

                                                                                                     Student Signature ________________________

7. FOR OFFICIAL USE.