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I

TANAGAR ARUNACHALPRADESH-
INDI
A

[
KINDLYFI
LLI
N BLOCK LETTERS]

Nameoft
heSt
udent(
Engl
ish):__________________________________________________________________________________

Nameoft
heSt
udent(
Hindi
):____________________________________________________________________________________

Fat
her
’sName:________________________________________________________________________________________________

Regi
str
ati
onNo.:______________________________________________________________________________________________

Nameoft
heCour
se:____________________________________________________________________________________________

_______________________________________________________________________________________________________________

Pas
singYear
:__________________________________________________________________________________________________

Ses
sion:______________________________________________________________________________________________________

Addr
essofCommuni
cat
ion:_____________________________________________________________________________________

_______________________________________________________________________________________________________________

___________________________________ Pi
nCode___________________________ PhoneNo.
:___________________________

Emai
l-I
D :______________________________________________________________Mobi
leNo.:__________________________

Dat
e:

Pl
ace:
(
Signat
ureofSt
udent
)

Theabovepart
icul
arsgi
venbyt
heappl
icantareveri
fiedandf
oundcorrect
.

FEE:5000/
- ModeofPayment Cas
h DD/
Cheque
[
DD t
obei
nfavourofHI
MALAYAN UNI
VERSI
TY]

Bank Amount
() DD No. Dat
e

Reques
trecei
vedon : Cer
tif
icat
eNo.:

Degr
eeCer
tif
icat
eIs
suedon: Aut
hor
isedSi
gnat
ory:

(
AllDocument ss
houldbes
elfat
tes
ted)
CopyofRegist
rati
onlett
er CopyofVivanotice
Copyofcours
ewor klet
ter Copyofresul
tnotif
icat
ion
CopyofSynopsisappr
ovallet
ter Copyofprovi
sional

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