3/18/2016

UGC_Student_Affidavit_Registration_Page

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ANTIRAGGINGUNDERTAKINGBYSTUDENTSANDPARENTS/GUARDIANS

Fieldsmarkedwithred*arecompulsory.
PersonalDetails
Student'sFamilyName*

EnteryourFamilyName

Student'sMiddleName

EnteryourMiddleName

Student'sFirstName*

EnteryourFirstName

Male

Gender*

Female

Nationality*

EnteryourNationality

Student'sMobileNumber*

+91 EnteryourMobileNo.

StudentsfriendsMobilenumberincaseofanemergency*

+91

LandlineNumber

+91

Student'semailID*

EnteryourEmailID

Confirmstudent'semailID*

EnteryourConfirmEmailID

EnteryourFriendMobileNo.

EnteryourLandlineNo.

EnteryourAddress1

PermanentAddress1*

EnteryourAddress2

Address2

City*
State*

EnteryourCity

State

Parent/GuardianDetails

Parent/Guardiansname*

EnteryourParent/GuardiansName

EnteryourAddress1

Parent/GuardianAddress1*

EnteryourAddress2

Address2

City*
State*

EnteryourCity

http://www.antiragging.in/Site/Affidavits_Registration.aspx

State

+91

EnteryourPhoneNo.

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3/18/2016

UGC_Student_Affidavit_Registration_Page
+91

ResidencePhoneNo*

EnteryourPhoneNo.

MobileNoofParent/Guardian*

+91

Parent/GuardiansEmailID*

EnterEmailAddress

EnteryourMobileNo.

CollegeDetails
StateinwhichtheCollegeis*

State

IsitaProfessionalCollegeoraGeneralCollege*

Select

NameoftheCollege*

EnteryourCollegeName

NameofAffiliatedUniversity*

Select

Yes

ItisDeemedUniversity*

No

Director/PrincipalFamilyName*

EnteryourDirector/PrincipalFamilyName

Director/PrincipalFirstName*

EnteryourDirector/PrincipalFirstName

Male

Director/principalGender*

Female

CollegePhoneNo.1*

+91

EnterCollegePhoneNo.

CollegePhoneNo.2

+91

EnterCollegePhoneNo.

NearestPolicestationNameandAddress*

EnteryourPoliceStationNameandAddress

CourseDetails
UnderGraduateorPostGraduate*

Select

NameoftheCourse*

EnteryourCourseName

YourRegistration/EnrolmentNumber

EnteryourRegistrationNo.

HowmanystudentsareinyourClass*

EnterTotalStudentInYourClass

YearofStudy*

Select

Pleaseenterthestringshownintheimage*

Next

Fieldsmarkedwithred*arecompulsory.

NationalAntiRaggingHelpLine(UGCCrisisHotline)
24x7TollFreeNumber*18001805522
(helpline@antiragging.in)
http://www.antiragging.in/Site/Affidavits_Registration.aspx

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