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    Application Form

    Uploaded by

    Shubham Joshi
    - The document is an academic registration and enrollment form for Shubham Joshi, a student enrolled in the 5th semester of the B.Tech Computer Science and Engineering program at Seemant Institute of Technology in Pithoragarh, Uttarakhand, India. - It provides personal details of Shubham Joshi such as name, father's name, date of birth, qualifications, enrollment details, declaration by the candidate, and certificate by the head of the institution. - The form is generated by Veer Madho Singh Bhandari Uttarakhand Technical University, Dehradun and contains details for registration and enrollment for the academic year 2022-23.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form

    Uploaded by

    Shubham Joshi
    63 views2 pages
    - The document is an academic registration and enrollment form for Shubham Joshi, a student enrolled in the 5th semester of the B.Tech Computer Science and Engineering program at Seemant Institute of Technology in Pithoragarh, Uttarakhand, India. - It provides personal details of Shubham Joshi such as name, father's name, date of birth, qualifications, enrollment details, declaration by the candidate, and certificate by the head of the institution. - The form is generated by Veer Madho Singh Bhandari Uttarakhand Technical University, Dehradun and contains details for registration and enrollment for the academic year 2022-23.

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    ApplicationForm

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    - The document is an academic registration and enrollment form for Shubham Joshi, a student enrolled in the 5th semester of the B.Tech Computer Science and Engineering program at Seemant Institute of Technology in Pithoragarh, Uttarakhand, India. - It provides personal details of Shubham Joshi such as name, father's name, date of birth, qualifications, enrollment details, declaration by the candidate, and certificate by the head of the institution. - The form is generated by Veer Madho Singh Bhandari Uttarakhand Technical University, Dehradun and contains details for registration and enrollment for the academic year 2022-23.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    63 views2 pages

    Application Form

    Uploaded by

    Shubham Joshi
    - The document is an academic registration and enrollment form for Shubham Joshi, a student enrolled in the 5th semester of the B.Tech Computer Science and Engineering program at Seemant Institute of Technology in Pithoragarh, Uttarakhand, India. - It provides personal details of Shubham Joshi such as name, father's name, date of birth, qualifications, enrollment details, declaration by the candidate, and certificate by the head of the institution. - The form is generated by Veer Madho Singh Bhandari Uttarakhand Technical University, Dehradun and contains details for registration and enrollment for the academic year 2022-23.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Veer Madho Singh Bhandari Uttarakhand Technical University, Dehradun

    A State Government University Established By Uttarakhand State Government


    Vide Act No.415 of 2005
    ACADEMIC REGISTRATION & ENROLMENT FORM : 2022-23

    Personal Details
    Registration No. : ST0000004851
    Application No. : AP220000010182
    College Code : 119
    College Name : SEEMANT INST. OF TECHNOLOGY PITHORAGARH
    Course Name : B.TECH
    Branch Name : Computer Science & Engineering
    Semester / Year : 5 Semester
    Student's Name : SHUBHAM JOSHI
    Father's Name : Prakash Chandra Joshi
    Mother's Name : Sundari
    Date of Birth : 12/01/2003
    Gender : Male
    Identification Marks : Mole under Nose
    Fee Category : False
    Aadhar Card No. : 567016270536 Category : GEN
    Religion : Hindu Sub Category : None
    Admission Mode : N/A Nationality : Indian
    Year of Admission : 2020 Country : N/A
    Admission Quota : N/A State : Uttarakhand
    Driving Licence No. : N/A District : Champawat
    PAN No. : N/A Pin Code : 262523
    Student's Email ID : shubhamjoshi1020@gmail.com Father's Mobile : 9758033373
    Student's Mobile No. : 9058065852 Digilocker ID : shubham0_0joshi
    Student's other Mobile No.: 9897081418 Academic : 384329056773
    Blood Group : B+ Bank Credit ID
    Address : Vill - Taliyabanj, Post - Budam, Naulapani, District - Champawat, Uttarakhand ,262523

    Qualification Details

    Name of Exam Board/University Year Roll No Max Mark Obt. Mark Percentage
    10th Board of school education 2018 18092352 500 423 84.60
    Uttarakhand
    12th Board of school education 2020 20474879 500 433 86.60
    Uttarakhand
    Fees Details

    Registration Fees (Rs) Enrolment Fees (Rs) Total Fees (Rs)


    0.00 0.00 0.00
    NOTE:-Attested Photocopy of Marks sheet of Qualifying Examination (i.e. Intermediate,Graduation Post Graduation etc.) and other
    relevant documents, must be attached with enrolment form.

    DECLARATION BY CANDIDATE
    1. I have read the rules in the relevant Ordinances applicable to me and undertake to abide by them and will not claim any benefit out
    of some error or mistake on the part of the University, which is not allowed under the ordinances.
    2. I hereby declare that the entries in the form are true to the best of my knowledge and belief, in case any entry in this form is found
    to be false. I will have no objection if theUniversity disqualifies me from appearing in examination/cancels my registration or
    debars me from appearing in the Examination in future.

    PRINT AS ON : 12/12/2022 *This is software generated report.* PAGE 1 OF 2


    Veer Madho Singh Bhandari Uttarakhand Technical University, Dehradun
    A State Government University Established By Uttarakhand State Government
    Vide Act No.415 of 2005
    ACADEMIC REGISTRATION & ENROLMENT FORM : 2022-23
    3. I, hereby declare that I shall not indulge in any act of indiscipline in Institution and University
    4. I hereby declare that I shall not be involving myself in any act that affects the dignity of any one.
    5. I'm fully aware that the desired details of Digilocker/ABC ID/Aadhaar, if not submitted here, will have to be submitted by January
    31, 2023. The registration/enrolment will remain provisional till submission of complete details & University will take necessary action
    as deemed suitable and withald the examination result due to any discrepancy.

    NOTE:-Those candidates who have been punished earlier for any reason are required to enclose the punishment order

    Date: 12/12/2022
    Signature of Candidate
    CERTIFICATE BY THE HEAD OF THE INSTITUTION

    · The entries made by the candidate in this Enrolment form have been checked and verified by the institute and are
    certified to be correct and candidate is found eligible to be permitted for Enrolment in the University.The candidate has
    deposited the requisite Examination and Enrolment Fee as prescribed by University.
    · It is also certified that the said student has been admitted to the concerned programme within the he approved admission
    capacity, prescribed by the University.
    · It is undertaken that in case of this admission being beyond the prescribed intake capacity of programme and is found to
    be violating the admission norms of the University, The University may cancel the admission
    for which no claim shall be made by the Institution and student.

    Date :_______________ Signature: _________________________

    Place:___________________ Name of Head of Institution: _________________

    Office Seal: _________________


    NOTE:-
    (1) Principal/Director should sign. himself on the above certificate and in no case facsimile stamp should be used.
    (2) The attached photocopy of all the certificates & marksheet must be attested by Director/Principal Dean of Institute with
    official Seal.

    ENDORSEMENT BY UNIVERSITY
    The candidate is enrolled in the university, however the university reserves right to cancel the enrolment in case of any
    information found incorrect/misconduct or any unforeseen situation, in which university decides to do so.

    Registrar
    VMSBUTU, Dehradun

    PRINT AS ON : 12/12/2022 *This is software generated report.* PAGE 2 OF 2

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