(RE-REGISTRATION FORM)
Re-Registration for
6
Semester
Enrollment No A21704822050
Name MR MAYANK GARG
Program BCA
Batch 2022-2025
Date of Birth 04/05/2004
E-Mail ID neerajgrg5@[Link]
132 TAGORE NAGAR DAYALBAGH AGRA
OPPOSITE MANU APARTMENT 282005
Contact Address
AGRA(Uttar Pradesh)
Pin code 282005
Phone 9410008100
Mobile 9410008100
Fax NA
Father's Name NEERAJ GARG
132 TAGORE NAGAR DAYALBAGH AGRA OPPOSITE MANU APARTMENT
282005
Parmanent Address
AGRA(Uttar Pradesh)
Pin code 282005
Phone 9410008100
Fax NA
Place of stay during this Semester (Non-Hostellers)
Address
City
Pin
Telephone
Mobile
E-mail
Hobby Club N/A
Date of payment of fees and fee receipt number : ______________________________
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 and I have met all
academic deadlines till now
Date : _____________________________
(Signature of the Student)
((Name & Signature of the Verifying Faculty))