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