Sie sind auf Seite 1von 3

Print Date & Time : 7/14/2016 1:18:29PM

JAI NARAIN VYAS UNIVERSITY, JODHPUR


Candidate Registration Form
SESSION : 2016 - 2017

(016) DEPARTMENT OF ELECTRONICS & COMMUNICATION ENGINEERING


Registration No. : J16U723983

Degree : B.E.

Applying For : GRADUATION

Registration Date : 14/07/2016

Form No. : ECE00298

Qualifying Exam Roll/Form No. :5013221


1. Name of the Candidate (

Enrollment No. :NA

(IN BLOCK LETTERS) :

PRATIK SINGH RATHORE


Name of the Candidate (

(IN HINDI) :

2. Father's Name (

(IN BLOCK LETTERS) :

MR. ROOP SINGH RATHORE


Father's Name (

(IN HINDI) :

3. Mother's Name (

(IN BLOCK LETTERS) :

MRS. UPDESH RATHORE


Mother's Name (

(IN HINDI) :

RAJASTHAN

4. Date of Birth :

02/03/1997

5. Domicile :

6. Gender :

MALE

7. Res. Category :

8. Category :

GEN

9. Caste Name :

10. Income Tax Payer :

NO

11. Aadhar No. :

12. Nominee Name/Relation :

ROOP SINGH RATHORE

13. Is Working? :

NO

14. Company Name :

NA

HINDU

17. Email ID :

pratiksingh199@outlook.com

19. Nationality :

INDIAN

15. Other Category :


16. Religion :

18. Do You Belong To Minority Category? :

NO

20. Have You Taken No Objection Certificate From (SP) (Optional) :

NO

21. Address

ENGLISH

22. Medium
Permanent Address

Address of Correspondence

Photo of Candidate

Address :
pratik singh rathore c/o roop singh rathore,
vill.= redi bhurwas, tas.= taranagar, dist.=
churu, raj. (331304)

Address :
pratik singh rathore c/o roop singh rathore,
vill.= redi bhurwas, tas.= taranagar, dist.=
churu, raj. (331304)

District :

District :

Pin :

churu
331304

Pin :

churu

Signature of Candidate

331304

Phone :
Mobile :

7728947425

Unique Identification Details


23. 10th Marksheet Sr. No. :

187922

24. 10th Roll No. :

2133394

25. 10th Passing Year :

2012

26. 12th Roll No. :

1655046

Last Submit Date & Time ( 7/14/2016 1:18:20PM) IST

Last Updated Date & Time ( 7/14/2016 1:18:20PM ) IST

Page 1 of 3

Print Date & Time : 7/14/2016 1:18:29PM

27. Whether you were punished for any offense / unfair means committed by you in the previously attended or the
present institution (If yes, give details ) :
28. Weightages Claimed :

29. Academic Record :


S. No. Examination Passed

Year

Matriculation

2012

Intermediate

2014

Max
Marks

Percentage/ ExamStream
Grade

Obt.
Marks

0.00

0.00

Subjects

Central Board of
Secondary Edu. 2,
Community Centre,
Shiksha Kendra, Preet
Vihar, Delhi-110 092.

B2

500.00 415.00

83.00%

Board/University

Physics Chemistry
Mathematics

Central Board of
Secondary Edu. 2,
Community Centre,
Shiksha Kendra, Preet
Vihar, Delhi-110 092.

30. Subject Details :

Compulsory subjects
1

--NA--

List of subjects/Combination and their preferences.


S. No. Subject Preferences

Preference

Electronics & Communication Engineering(ECE)

NOTE: Mark the number of documents ( Photocopy/Xerox) attached by the Candidate during form submission to the college :
(a)

Xth Marksheet

(b) Xth Certificate.

(c) XIIth Marksheet.

(d)
(g)
(j)
(m)

Last Exam Passed Marksheet


Domicile (for other state)
Certificate for Vert./Caste Category
Migration Certificate

(e)
(h)
(k)
(n)

(f) Signature
(i) Certificate for Horz./Reservation Category
(l) Character Certificate
(o) Gap year Certificate

Photograph
Certificate for Kashmiri Migrants.
Transfer Certificate
Income Certificate

(p) Ward of University(if Applicable)

Last Submit Date & Time ( 7/14/2016 1:18:20PM) IST

Last Updated Date & Time ( 7/14/2016 1:18:20PM ) IST

Page 2 of 3

Print Date & Time : 7/14/2016 1:18:29PM

Undertaking
1. /
/ |
2. / |
3. / ,
/
/ |

4. / / |
5. / / 100%
/ 75% / |
6. , / / |
7.

|
/
/ | / |
/ / |

Dated :

Signature of the Applicant him / herself

Signature of Parent's/Guardian
Last Submit Date & Time ( 7/14/2016 1:18:20PM) IST

Last Updated Date & Time ( 7/14/2016 1:18:20PM ) IST

Student Receipt
Registration No. : J16U723983

Registration Date : 14/07/2016

Print Date & Time : 7/14/2016 1:18:29PM

Form No. : ECE00298

College Name : (016) DEPARTMENT OF ELECTRONICS & COMMUNICATION ENGINEERING


Degree :

Receiver's Signature

B.E.

Last Submit Date & Time ( 7/14/2016 1:18:20PM) IST

Last Updated Date & Time ( 7/14/2016 1:18:20PM ) IST

Page 3 of 3

Verwandte Interessen