Vous êtes sur la page 1sur 5

Shaheed Bhagat Singh State Technical Campus Ferozepur

Moga Road, Ferozepur-152004


REGISTRATION FORM FOR SEMESTER -- Jan-June, 2018

Hosteller/Day Scholar Department Copy/Hostel Copy/Student Copy

To be filled by HOD/Competent Official Registration


(Tick the appropriate boxes) Date
All documents attached Yes No
Fee Payment Status Paid Pending
Late Registration Fine Payment Status Not Applicable Paid Pending
Registration Status Registered Registered Not
Provisionally Registered
Fee Category of Student EWS Tuition Fee SC/ST Post General Fee Signature and Stamp of
Waiver Matric HOD/Competent Official
Remarks, if any:

1.:Name of student ;……………………………….…………. Fix your


Passposrt
2. University Roll Number:
Size Coloured
3. Course Name ………………… Photograph
Here
4. Semester:………………..

5. Fee and Fine Payment Details:


1.(Fee Details) Amount..................... Receipt No.:…………………….. Date.........................................................
2.(Late Registration Fine, if applicable) Amount .....................Receipt No.:…………… Date...............................
3. Pending Fee Details(if any)……………………………………………………………………………………………………………………………

6. Mobile Number:..........................................
7. Contact Number of Parents: 1 ............................. 2 ......................................
8. Is there a pending UMC case against you ? Yes/No (Tick one) If

yes, attach affidavit in this regard in the prescribed format.

DECLARATION BY STUDENT
I have checked that all the copies (Department Copy, Hostel Copy and Student Copy) of registration form
are completely filled, with passport size coloured photograph pasted on each copy. All the information filled
by me in registration forms is correct.
I have attached the following documents (Tick appropriate) with Department Copy of the form:
(i) Copy of Fee Voucher/College Fee Receipt
(ii) College Receipt of late fee, if applicable.
(iii) Anti-ragging affidavits by the student and his/her parents separately in prescribed performa
(iv) Copy of receipt of payment of pending dues
(v) UMC Case affidavit, if applicable

Date Signature of the Student


Shaheed Bhagat Singh State Technical Campus Ferozepur
Moga Road, Ferozepur-152004

DETAINEE REGISTRATION FORM FOR SEMESTER ---- Jan-June, 2018


Hosteller/Day Scholar ODA Copy/Department Copy/Student Copy
To be filled by HOD/Competent Official Registration
(Tick the appropriate boxes) Date
All documents attached Yes No
Fee Payment Status Not Needed Paid Pending
Late Registration Fine Payment Status Not Applicable Paid Pending
Registration Status Registered Registered Not
Provisionally Registered
Fee Category of Student EWS Tuition Fee SC/ST Post General Fee Signature and Stamp of
Waiver Matric HOD/Competent Official
Remarks, if any:

1. : :Name of student ;…………………………… Fix your


Passposrt
2. University Roll Number:
Size Coloured
3. Course Name ………………… Photograph
Here
4. Current Semester (Circle Appropriate):. II, IV, VI, VIII, X, XII, XIV

5. Fee and Fine Payment Details: (Only students of current semester X, XII and XIV require to pay fee)
1.(Fee Details) Amount..................... Receipt No.:………………………………. Date...............................................
2.(Late Registration Fine, if applicable) Amount ..................... Receipt No.:……………….. Date..........................

6. Mobile Number:..........................................
2.....................................
7. Contact Number of Parents: 1..................................... .

8. Is there a pending UMC case against you ? Yes/No (Tick one) If


yes, attach affidavit in this regard in the prescribed format.
Semester of Course Theory/ Faculty Member Allotted (To be filled by Department)
Detention Code Practical

DECLARATION BY STUDENT

I have checked that all the copies (Academic Copy, Department Copy and Student Copy) of registration form are
completely filled, with passport size coloured photograph pasted on each copy. All the information filled by me in
registration forms is correct. I have attached the following documents (Tick appropriate) with Department Copy
of the form: (i) Copy of Fee Voucher; (ii) College Receipt of late fee and (iii) UMC Case affidavit, if applicable

Date Signature of the Student


BANK COPY DEPTT COPY ACCOUNTS SECTION COPY STUDENT COPY
Jan 2018-June2018 Jan 2018-June2018 Jan 2018-June2018 Jan 2018-June2018
SBSSTC,FZR SBSSTC,FZR SBSSTC,FZR SBSSTC,FZR
(Shaheed Bhagat Singh State Technical Campus) (Shaheed Bhagat Singh State Technical Campus) (Shaheed Bhagat Singh State Technical Campus) (Shaheed Bhagat Singh State Technical Campus)
Accont Name Director SBSSTC, Ferozepur Accont Name Director SBSSTC, Ferozepur Accont Name Director SBSSTC, Ferozepur Accont Name Director SBSSTC, Ferozepur
Bank Name HDFC BANK Bank Name HDFC BANK Bank Name HDFC BANK Bank Name HDFC BANK
Account No 50200019823642 Account No 50200019823642 Account No 50200019823642 Account No 50200019823642
Branch FEROZEPUR CANTT Branch FEROZEPUR CANTT Branch FEROZEPUR CANTT Branch FEROZEPUR CANTT
IFSC CODE HDFC0002783 IFSC CODE HDFC0002783 IFSC CODE HDFC0002783 IFSC CODE HDFC0002783

Student Name Student Name Student Name Student Name

Father Name Father Name Father Name Father Name

Roll No. Roll No. Roll No. Roll No.


Category(pl Tick) Gen/Fee Waiver/SC & ST Category(pl Tick) Gen/Fee Waiver/SC & ST Category(pl Tick) Gen/Fee Waiver/SC & ST Category(pl Tick) Gen/Fee Waiver/SC & ST
Semester& Branch Semester& Branch Semester& Branch Semester& Branch

Amount Amount Amount Amount


(In Words) (In Words) (In Words) (In Words)

By Cash/DD By Cash/DD By Cash/DD By Cash/DD


DD No. & Date DD No. & Date DD No. & Date DD No. & Date
Bank Name Bank Name Bank Name Bank Name

Student Signature Student Signature Student Signature Student Signature


Received Amt Received Amt Received Amt Received Amt

Autho Signature Autho Signature Autho Signature Autho Signature

If you have any problem please contact: If you have any problem please contact: If you have any problem please contact: If you have any problem please contact:
Jatinder Singh ( Branch Manager): 93564-15612 Jatinder Singh ( Branch Manager): 93564-15612 Jatinder Singh ( Branch Manager): 93564-15612 Jatinder Singh ( Branch Manager): 93564-15612
Branch: 01632-242076 Branch: 01632-242076 Branch: 01632-242076 Branch: 01632-242076
BANK COPY DEPTT COPY ACCOUNT SECTION COPY STUDENT COPY
Jan 2018-June2018 Jan 2018-June2018 Jan 2018-June2018 Jan 2018-June2018
SBSSTC,FZR SBSSTC,FZR SBSSTC,FZR SBSSTC,FZR
(Shaheed Bhagat Singh State Technical Campus) (Shaheed Bhagat Singh State Technical Campus) (Shaheed Bhagat Singh State Technical Campus) (Shaheed Bhagat Singh State Technical Campus)
Accont Name Director SBSSTC, Ferozepur Accont Name Director SBSSTC, Ferozepur Accont Name Director SBSSTC, Ferozepur Accont Name Director SBSSTC, Ferozepur
Bank Name State Bank of India Bank Name State Bank of India Bank Name State Bank of India Bank Name State Bank of India
Account No 65119587025 Account No 65119587025 Account No 65119587025 Account No 65119587025
Branch SBS College, Ferozepur Branch SBS College, Ferozepur Branch SBS College, Ferozepur Branch SBS College, Ferozepur
IFSC CODE SBIN0051175 IFSC CODE SBIN0051175 IFSC CODE SBIN0051175 IFSC CODE SBIN0051175

Student Name Student Name Student Name Student Name

Father Name Father Name Father Name Father Name

Roll No. Roll No. Roll No. Roll No.


Category(pl Tick) Gen/Fee Waiver/SC & ST Category(pl Tick) Gen/Fee Waiver/SC & ST Category(pl Tick) Gen/Fee Waiver/SC & ST Category(pl Tick) Gen/Fee Waiver/SC & ST
Semester& Branch Semester& Branch Semester& Branch Semester& Branch

Amount Amount Amount Amount


(In Words) (In Words) (In Words) (In Words)

By Cash/DD By Cash/DD By Cash/DD By Cash/DD


DD No. & Date DD No. & Date DD No. & Date DD No. & Date
Bank Name Bank Name Bank Name Bank Name

Student Signature Student Signature Student Signature Student Signature


Received Amt Received Amt Received Amt Received Amt

Autho Signature Autho Signature Autho Signature Autho Signature

Centres d'intérêt liés