CHANDIGARH ENGINEERING COLLEGE - JHANJERI, MOHALI
REGISTRATION FORM (Branch – Semester)
STUDENT’S PHOTO FATHER’S PHOTO MOTHER’S PHOTO
NOTE:
a) Student is advised to fill all the information correct and in Block Letters.
b) Student Name, Father’s Name, Mother’s Name, DOB etc must be as per High School Certificate (10th Class).
1. NAME OF CANDIDATE: ______________________________________________________________________
2. UNIVERSITY ROLL NO.:______________________________________________________________________
3. FATHER’S NAME: _________________________________________________________________________
4. MOTHER’S NAME: _________________________________________________________________________
5. DATE OF BIRTH : __________________________________NATIONALITY : _________________________
6. GENDER (M/F) : ____________________________________% IN 12TH : _______________________________
7. STREAM: __________________________ (WITH/ WITHOUT MATHS) ________________________________
8. COLLEGE: _________________________________________________COURSE: _________________________
9. LAST SEMESTER RESULTS:
IST SEM : _______________________________ 2ND SEM : _________________________________
3RD SEM: _______________________________ 4TH SEM : __________________________________
5TH SEM: _______________________________ 6TH SEM: ___________________________________
10. E- MAIL ID: ___________________________________________________________________________________
11. MOBILE NO: Self _______________________Father _______________________ Mother ___________________
12. CURRENT ADDRESS: ___________________________________________________________________________
_______________________________________________________________________________________________
PERMANENT ADDRESS: ________________________________________________________________________
_______________________________________________________________________________________________
13. CATEGORY: GEN/OBC/SC/ST/MIN ______________________RELIGION: ______________________________
14. FEE PAID: YES/NO AMOUNT: __________________TRANSACTION ID/RECIEPT NO.: ___________________
15. AVAILING TRANSPORT: YES/NO, PICK POINT: _______________, FEE PAID:YES/ NO Amount: ___________
RECIEPT NO.: ______________________OWN VEHICLE NO: __________________________
16. HOSTEL FACILITY AVAILED: YES/ NO, FEE PAID AMOUNT(ATTACH RECIEPT):____________________
17. EXTRA CURRICULAR / CO-CURRICULR PARTICIPATION (IF ANY): _______________________________
18. DULY FILLED AFFIDAVIT SUBMITTED: YES/ NO. (NO REGISTRATION FORMS ARE ACCEPTABLE IF NOT)
I__________________________________ S/O, D/O ________________________________________ hereby declare that all the information given
above is true to the best of my knowledge & belief. If any information is later on found to be incorrect, I shall personally be liable for that and
college may initiate any disciplinary action against me. I also abide to inform you in case of change of phone numbers and address.
(Signature of Student) (Signature of Father) (Signature of Mother)
ACCEPTED/REJECTED SIGNATURES OF CC: SIGNATURES OF HOD WITH STAMP:
