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Student Membership Form

Personal Information

(Use Capital letters only)

Name:

Courses:

Email:

Mobile NO:

Department:

Date of Birth:

Gender:

Father's Name:

Local Guardian Name:

Local Guardian Mobile NO:

Year of Session/Batch:

Blood Group:

Aadhar NO:

Photo:

Contact Information

Permanent Address:

City:

Pincode:

Local Address:

City:

Pincode:

Student Contact No:

Emergency No:

Email:

Declaration and Undersigned:

The undersigned would like to Applied for library membership. I am aware of undertake abide by the copyright act 1986 and amendments. I will update to library of any change in my contact details. I agree to observe the library rules

Date:

Student Signature:

The photograph and details furnished by student is verified and found correct as per official records of Departments/Institute.He/she deposited the course fees for current Session

............................................................................................

Seal of Dept

(Signature Of HOD)

For Central Office Use only

Library Id

issue no:

Student Membership Form

Personal Information

Contact Information

Declaration and Undersigned:

For Central Office Use only

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