RE-REGISTRATION FORM (For External Students) Registration Number 1. RE-REGISTRATION FOR SEMESTER: I II III IV V VI VII VIII 3. PROGRAMME: 2. YEAR: 2 0 1 Paste Recent Passport size coloured Photograph Programme Code: Write your Name and Registration Number on the reverse side of the Photograph of the Student of 4 x 3 cm in this box only do not use pin or stapler Specialisation: Programme Name: (If any) 4. ELECTIVE SUBJECT: 1. (If any) 2. 3. 4. (upload for online submission) 5. PERSONAL INFORMATION: (a) Name of the Applicant (exactly as it appears on academic High School Transcript / Certificate of qualifying examination) (b) Father's Name: (c) Mother's Name: (d) Gender: (e) Date of Birth: Male Female Other D (f) Correspondence Address (for all communication by the University): Distt.: D M M Y Y Y Y State : PIN Code: Post Office: Country Code: STD Code: Mobile No. (For SMS Alert): Telephone No.: Mobile No. (Alternate Number): E-mail Address: ___________________________________________________ 6. RE - REGISTRATION FEE DETAILS DD No./ Challan No. / Cash Receipt No. Date Amount: D Bank & Branch: D M M Y Y Y Y Demand Draft should be in favour of "APEX Professional University" payable at “Pasighat (Arunachal Pradesh)" 7. DECLARATION /UNDERTAKING FROM THE APPLICANT I hereby certify that all the particulars stated in this Re-Registration Form are true to the best of my knowledge & belief. In the event of suppression or distortion of any fact made in my Re-Registration Form, I understand that my Re-Registration is liable to be cancelled. I understand that University has the right to add/delete/change the syllabi, course structure, rules & regulations as and when required, as per change in environment. I understand that FEES once paid will NOT be refunded Date D D M M Y Y Y Y Signature of the Applicant
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