1. No category

STUDENT INFORMATION SHEET – CLASS OF 2015-17
Application No.
A
P
U
1
5
P
Admission No.
Programme
G
(Admission number to be filled on registration day)
Name in Full (Block letters)
__________________ __________________ ____________________
First Name
Middle Name
Last Name
Name as in University Records
(Please note that our University records will reflect
this)
Date of Birth (DD/MM/YYYY)
Updated Bangalore mobile number
(Once you get this, please ensure that it is updated to
the Student and Accommodation Help Desk)
Father/Guardian Name
If Guardian, relationship with the student
Mobile Number
Email ID
Mother/Guardian Name
If Guardian, relationship with the student
Mobile Number
Email ID
Permanent Address
Contact Number (land line)
Local Contact, if any
Name
Address
Mobile Number
Email ID
DECLARATION
I hereby declare that the information furnished above is true and correct. The University will not be held
responsible for any issues, arising on account of this information being false or incorrect. I agree to update the
Registrar’s office, in case of any change in the contact details. Once I obtain a mobile number in Bangalore, I agree to
update this to the Student and Accommodation Help Desk.
I hereby furnish a photocopy of Driving License/Passport/Voter ID/Aadhaar Card as an identity and address proof
to support the above.
I understand that the University will reach out to any of the above mentioned contacts, if need be, to keep them
appraised of University related concerns of any kind.
Place:
Date:
Signature of the student