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B.Tech CSE Re-Registration Form

The document is a re-registration form for a student named Mr. Piyush Rajesh Khalate, enrolled in the B.Tech (CSE) program for the 8th semester. It includes personal details such as contact information, permanent address, and father's name, along with a section for fee payment and hostel accommodation. The student acknowledges that their registration is provisional and must meet academic requirements to remain valid.

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Piyush Khalate
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11 views2 pages

B.Tech CSE Re-Registration Form

The document is a re-registration form for a student named Mr. Piyush Rajesh Khalate, enrolled in the B.Tech (CSE) program for the 8th semester. It includes personal details such as contact information, permanent address, and father's name, along with a section for fee payment and hostel accommodation. The student acknowledges that their registration is provisional and must meet academic requirements to remain valid.

Uploaded by

Piyush Khalate
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

(RE-REGISTRATION FORM)

Re-Registration for
8
Semester
Enrollment No A70405215026
Name MR PIYUSH RAJESH KHALATE
Program [Link] (CSE)
Batch 2015-2019
Date of Birth 09/10/1996
E-Mail ID khalatepiyush@[Link]
[Link] VISHNUPRASAD PARK, SUBHASH ROAD,
NAVAPADA
Contact Address
DOMBIVALI WEST(Maharashtra)
Pin code 421202
Phone 7506947019
Mobile 7506947019
Fax NA
Father's Name RAJESH KHALATE
[Link] VISHNUPRASAD PARK, SUBHASH ROAD, NAVAPADA
Parmanent Address
DOMBIVALI WEST(Maharashtra)
Pin code 421202
Phone 7506947019
Fax NA
Place of stay during this Semester (Non-Hostellers)
Address
City
Pin
Telephone
Mobile
E-mail

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))

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