West Bengal University of Technology Application Form For Registration
West Bengal University of Technology Application Form For Registration
West Bengal University of Technology Application Form For Registration
MAMB
(Application ID)
The Registrar, West Bengal University of Technology BF-142, Saltlake, Sector-1 Kolkata-700064, West Bengal
Sir, I hereby apply for registration as a student of West Bengal University of Technology. A sum of Rs. 400/- is remitted herewith as Registration Fee for the academic session 2012-2013. Necessary particulars relating to myself, given below, are true to the best of my knowledge. Place:_______________ Date: _______________ Signature of Applicant (Please Sign within the box)
Registration applied for : General Entry to 1st Semester Roll No. (if Re-Admission / Branch Change): Registration No. (if Re-Admission / Branch Change): Session Year : 2012-2013 Degree : B. Tech. Registration Against : WBJEEE Enrollment No: 3810050518 Name : Sudip Kumar Pathak Rank & Category : (WBJEEE), 16395 (GEN) College Name : JIS College of Engineering Course : B.Tech. in Electronics & Communication Engineering Applying for concession : NA
(TFW)
Sex: MALE Category: GEN Physically Challenged: N Nationality : Indian Religion : Hindu Father's Name : Sisir Kr Pathak Mother's Name : Suvra Pathak Address : 7, Seth Bagan Place, Dum Dum Junction, Kolkata PIN-700030 Phone: 9433974999 Email: [email protected] Guardian's Name : Sisir Kr Pathak Address1 : 7, Seth Bagan Place, Dum Dum Junction, Kolkata Address2 : PIN-700030
Name of School/College or University of which he/she was a student prior to this admission:Hindu School
Photo Uploaded: Y
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Student Name : Sudip Kumar Pathak (Application ID : MAMB) Name of College/Institution where you have been admitted :_________________________________________________________________________________________ The particulars mentioned in page 1 of registration form are true to the best of my knowledge. I shall abide by the rules & regulations of the West Bengal University of Technology. _________________________________________ Full Signature of student with date. Checked and Forwarded by __________________________________________ Signature of Director / Principal / Teacher-in-charge Name of College/Institution ____________________ __________________________________________ College Code _______________________________ Date: ______________ Place __________________ _________________________________________ Full Signature of Guardian with date
Seal ________________________________
.................................................. Full Signature of the Candidate Date: ......................................... Submission Date: 2012-11-01 12:55:24