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Proforma (Student Information Form)

The document contains a student information form providing personal details of a student including name, date of birth, gender, branch, semester, roll number, admission number, present and permanent addresses, contact details, identification marks, details of father/guardian including name, educational qualifications, occupation, income, address and contact details. It also includes mother's name, educational qualification, occupation, income, contact details, landline number, caste, physical handicap status, mother tongue, blood group, contact person in case of medical emergency, name and number of doctor, name of counselor, qualifying exam details, hall ticket number, rank, distance from residence, place of birth, bank account number and type of admission. The student

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2K views2 pages

Proforma (Student Information Form)

The document contains a student information form providing personal details of a student including name, date of birth, gender, branch, semester, roll number, admission number, present and permanent addresses, contact details, identification marks, details of father/guardian including name, educational qualifications, occupation, income, address and contact details. It also includes mother's name, educational qualification, occupation, income, contact details, landline number, caste, physical handicap status, mother tongue, blood group, contact person in case of medical emergency, name and number of doctor, name of counselor, qualifying exam details, hall ticket number, rank, distance from residence, place of birth, bank account number and type of admission. The student

Uploaded by

nandannamburi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

B.Tech 2.

/4 – (EEE) Section: b
Roll No: 1210509216

Student Information Form

STUDENT PERSONAL DETAILS Student

Student Name (full name): Photo


Date of Birth:
Gender: Male
Branch: eee Sem: 4 Roll No: Admission
No:1210509213
Present Address:gitam hostel

Permanent Address: :

Contact No. of Student: E-Mail Id:


Identification Marks (As given us X class marks)

1.A mole on left hand

2a mole in left eye

Details of the Father / Guardian


Father Name:
Educational Qualifications: m.tech Parent
Occupation: Photo
Gross Income:
Office Address:

Phone No: Email:


Mother Name:
Educational Qualification
Occupation:
Gross Income:
Office Address:

Page 1 of 2
Mobile No: Email:
Land Line:

Specific Information:
Caste: OC
Physically Handicapped: --
Mother Tongue: telugu
Blood Group:
Contact person (in Medical Emergency): Name of the Doctor:
Phone Number:
Name of the counselor:
Qualifying Exam Details :
Name of Exam:gat
Hall Ticket Number:
Rank:3894
General :
Distance from residence:0.5 km
Place of Birth:repalle
Bank Account no of Gitam Branch:
Type of Admission:
1) Convener
Declaration: The above information furnished by me is true to the best of my
knowledge. I am liable for any disciplinary action to be taken by the
college in case the information submitted by me was found false
later.

Date: Signature of the Student

Head of the Department

Page 2 of 2

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