enu eksgu ekyoh; bathfu;fjax dkyst] xksj[kiqj - Madan Mohan Malviya ...

enu eksgu ekyoh; bathfu;fjax dkyst] 

xksj[kiqj 

Lk= 2013&2014 uo izosf'kr Nk=@Nk=kvksa gsrq vfr&vko”;d lwpuk 

enu eksgu ekyoh; bathfu;fjax dkyst] xksj[kiqj+ ds l= 2013&2014 esa uo izosf’kr Nk=&Nk=kvksa dh 

Reporting dk;ZØe fuEu vuqlkj izLrkfor gS %& 

Ø0la0 dkslZ ,oa o"kZ Lke; iathdj.k dh frfFk 

01- ch0Vsd0] izFke o"kZ Ikzkr%9-30 cts l 1-00 cts rd 05 vxLr 2013 

02- 

ch0Vsd0] f}rh; o"kZ Ikzkr%9-30 cts l 1-00 cts rd 05 vxLr 2013 

(Lateral Entry) 

03- ,e0lh0,0] izFke o’kZ Ikzkr%9-30 cts l 1-00 cts rd 05 vxLr 2013 

04- ,e0ch0,0] izFke o’kZ Ikzkr%9-30 cts l 1-00 cts rd 05 vxLr 2013 

lHkh Nk=&Nk=k,a mijksDr frfFk esa mifLFkr gksdj Report djus dk d"V djsaA Registration 

'kqYd ,oa vU; lwpuk,a egkfo|ky; dh csclkbV www.mmmec.ac.in ij miyC/k gSaA osclkbZV ij miyC/k 

pkyku QkeZ vFkok usV&cSafdx ds }kjk Nk= lh/ks 'kqYd egkfo|ky; [kkrs esa dgha ls Hkh tek dj ldrs gSaA 

izkIr gksus okyh tek jlhn dh ,d izfr vFkok pkyku QkeZ dh dkyst dkih Nk= QkeZ ds lkFk layXu dj 

iathdj.k ds fy, mifLFkr gksaxsA 

1. College fee (excluding mess fee) should be deposited through I-Collect/PowerJyoti Challan (Account No: 

31580851255) attached at the end of this document. 

2. Mess fee should be deposited separately through mess challans only which are attached at the end of this 

document. For Boys, challan of Vishveswarya Bhawan and for girls, challan of Sarojini Bhawan should 

be used. 

Please bring soft copy of Photo (passport size)(

M. M. M. Engg. College Gorakhpur-273010 

July 30, 2013 

NOTICE 

(B. Tech. Ist Year & B. Tech. IInd Yr. students (Lateral Entry for Diploma Holders/B.Sc. Graduates) 

All B. Tech. Ist Year & B. Tech. IInd Yr. students (Lateral Entry for Diploma Holders/B.Sc. Graduates), who have been 

allotted this college for their admission through SEE–2013, are hereby informed to report at college on August 05, 2013 at 9.30 

hrs. The candidates are required to come with following documents in original and four sets of photocopies. 

1. High School Certificate 

2. Intermediate Mark Sheet. 

3. B. Tech. IInd Yr. students (Lateral Entry for Diploma Holders/B.Sc. Graduates) - 

a. Diploma Holders will submit TC & Final Yr. Diploma Mark Sheet. 

b. B.Sc. Graduates will submit Migration Certificate & Graduation Mark Sheet 

4. Domicile Certificate (if applicable) 

5. Caste Certificate (if applicable) 

6. Admission letter 

7. Rank letter. 

8. Fee receipts of fee deposited i.e. Rs.500, Rs.10000 at counseling center. 

9. College Copy & Student Copy of challan by depositing College Fee 

10. Fifteen copies of colored passport size photographs. 

11. Transfer Certificate for students from U.P. Board, whereas, TC & Migration both for the students from other Boards. 

12. Income Certificate (after March 31, 2013). One Notary Affidavit for Scholarship, it applicable. 

13. Two Notary Affidavits by the student and another notary affidavit by parent/guardian for the UGC regulation on Curbing 

the menace of Ragging in Higher Educational Institutions 2009 (format and details are given below) 

14. Please bring soft copy of passport size photo (size less than 100 KB) and scanned signature (size less than 100 KB) at the time of admission. 

All the students are required to come with bag and baggage on August 05, 2013. 

(Dr. K.G. Upadhyay) 

Dean-Academics 

* Note- (1) For the students of SC/ST, scholarship/fee reimbursement form with affidavit completed in all respect is 

needed at time of registration (format for scholarship is given below and also available at www.mmmec.ac.in), otherwise, 

no exemption will be given. 

(2) This is subject to reimbursement of fee from “Samaj Kalyan Vibhag” within 45 days as per government order.

M. M. M. Engg. College Gorakhpur-273010 

NOTICE for MBA/MCA 

July 30, 2013 

All MBA/MCA candidates who have been allotted this college for their admission through SEE–2011 are hereby informed to 

report at college on August 05, 2013 at 9.30 hrs. The candidates are required to come with following documents in original and 

two sets of photocopies. 

1. High School Certificate 

2. Intermediate Mark Sheet. 

3. Graduation Mark Sheet 

4. Domicile Certificate (if applicable) 

5. Caste Certificate (if applicable) 

6. Admission letter 

7. Rank letter. 

8. Fee receipts of fee deposited i.e. Rs.500, Rs.10000 at counseling center. 

9. College Copy & Student Copy of challan by depositing College Fee 

10. Fifteen copies of colored passport size photographs. 

11. Migration Certificate. 

12. Income Certificate (after March 31, 2013). One Notary Affidavit for Scholarship, it applicable. 

13. Two Notary Affidavit by the student and another notary affidavit by parent/guardian for the UGC regulation on Curbing 

the menace of Ragging in Higher Educational Institutions 2009 (format and details are given below). 

All the students are required to come with bag and baggage on August 05, 2013. 

(Dr. K.G. Upadhyay) 

Dean-Academics 

* Note- (1) For the students of SC/ST, scholarship/fee reimbursement form with affidavit completed in all respect is 

needed at time of registration (format for scholarship is given below and also available at www.mmmec.net), otherwise, no 

exemption will be given. 

(2) This is subject to reimbursement of fee from “Samaj Kalyan Vibhag” within 45 days as per government order.

Madan Mohan Malaviya Engineering College 

Gorakhpur-273010 (U.P.) 

(Affiliated to Gautam Buddha Technical University, Lucknow) 

Academic Registration Form 

B.Tech./MCA/MBA/M.Tech./Ph.D. Year I/II/III/IV Session 201 -1 , Even/Odd Semester I/II/III/IV/V/VI/VII/VIII 

Students Mobile No._____________________________________ 

Name of the Student________________Date of Birth___________ 

Branch ___________________Registration No.________________ 

SEE Roll No. ______________General Rank__________________ 

Category___________________Category Rank________________ 

Branch ___________________Category_____________________ 

Gender___________________Religion______________________ 

Father’s Name _______________ Hosteller/Day Scholar________ 

Affix Pass port size 

photograph with signature 

Signature of the Student 

Signature of HOD/Faculty 

Any Scholarship received____________________________ 

Fee Reimbursement, if applicable______________________ 

Semester Fee Details: 

Challan/Demand Draft No.__________ Dated ____________ 

Amount___________________ Bank _______________________ 

Sig. & Seal of Scholarship Official 

Sig. & Seal of Account official 

Name of the Hostel--------------------------------Room No.-------------- 

Mess Fee details------------------------------------------------------------- 

Sig. & Seal of Hostel Official 

Permanent Address ---------------------------------------------------------------------------------- 

-------------------Pin Code------------------------Mobile------------------- 

Details of Local Guardian, if any (Name, Address and Phone number) ------------------------------------------------------------------------ 

----------------------------------------------------------- 

Signature of Dean (Academic) 

Signature of DSA 

Acknowledgment Slip 

Mr/Ms ----------------------------------------------Course B.Tech./MCA/MBA/M.Tech./Ph.D. Year ----------- Semester-------------- 

Branch ----------------------------------------University Roll No. --------------------------------Name of the Hostel--------------------------- 

----------- --has been registered on ------------------ 

Signature & Seal of Dean Academic 

Signature & Seal of DSA




Please fill all information in CAPITAL Latter only. 

Student Information 

1. Registration No………………………………………………… 

Student’s Id-Card 

2. First Name……………………………………………………… 

3. Middle Name…………………………………………………… 

4. Last Name……………………………………………………… 

5. Father’s Name…………………………………………………… 

6. Mother’s Name…………………………………………………… 

7. Date of Birth…………………………………………………… 

8. Gender (M/F)………………… Category …………………… 

9. Address…………………………………………………………… 

10. City………………………………………………………………… 

11. State………………………………………………………………. 

12. Pin Code…………………………………………………………. 

13. Phone Number…………………………………………………………… 

14. Mobile Number…………………………………………………………… 

15. E-mail…………………………………………………………… 

16. Branch…………………………………………………………… 

17. Course…………………………………………………………… 

18. Year……………………………………………………………… 

19. Blood Group……………………………………………………. 

20. Joining Date……………………………………………………… 

21. Signature Signature

Hostel Registration Form 

B.Tech./MCA/MBA I/II/ Year Session 2013-14, Semester I/III 

Name of the Student________________Date of Birth___________ 

SEE Roll No. _______________ _____Registration no__________ 

Branch ___________________Category_____________________ 

Year______________________Semester_____________________ 

Father’s Name _______________ Mother,s Name______________ 

Name of Hostel_____________Room No.____________________ 

Physically handicapped YES/NO 

Status of the Student REGULAR/EX/RE-ADMITTED 

Blood Group 

Are you under any regular treatment? If yes, Give Details. 

Affix Pass port size 

photograph with signature 

Nearest Railway Station 

Nearest Airport 

Mobile No. 

Teacher Guardian Name……………………. 

e-mail id 

Name of Room Partner Course/Branch/Year Mobile No 

1 ……………………… ……………………… ……………………… 

2……………………… ……………………… ……………………….. 

3……………………… …………………….. ………………………. 

Emergency Mobile Contact No. 

Mess Fee details 

Challan/Demand Draft No……………………..Dated ……..…………. 

Amount Rs. ………………………… Bank……………………………. 

Sig. & Seal of Hostel Official 

Permanent Address ----------------------------------------------------------------------------------------------------------------------- 

-------------------------------------------------------------------------------------------------------------------------------------------------- 

-------------------------------------------------------------------------------------------------------------------------------------------------- 

-------------------Pin Code------------------------Mobile No. -------------------e-mail id…………………… 

Details of Local Guardian, if any (Name, Address, e-mail id and Mobile Number) ----------------------------------------------- 

-------------------------------------------------------------------------------------------------------------------------------------------------- 

-------------------------------------------------------------------------------------------------------------------------------------------------- 

Pin Code------------------------Mobile No. -------------------e-mail id…………………… 

Signature of the Student 

Signature of Parents 

Signature of Hostel Warden 

Signature of Chief Warden

ANTI-RAGGING MEASURES : SUBMISSION OF AFFIDAVIT BY THE STUDENTS / PARENT / GUARDIAN 

Dear Parents/Guardian/Student, 

You are fully aware of the orders of the Government and of Hon'ble Supreme Court on the Anti-Ragging measures. As per the 

latest policy all students and parent/guardians are required to submit an affidavit before a student is allowed registration in the 

University. The format of Affidavits are attached herewith and to be submitted on a Non-Judicial Stamp Paper of Rs.10/- duly 

attested by the oath commissioner. 

All parents/guardian/students may download the same and get them duly attested by the Oath commissioner and bring it on the 

day of student’s registration. Kindly note that there are three Affidavits as Annexure-I, II & III. The Annexure-I is to be signed 

by the student, Annexure-II shall be signed by the parent / guardian and Annexure III is to be signed by the student residing in the 

hostel. 

In case a student does not submit the same he/she shall not be allowed to proceed with the registration. 

It is further, requested that this information be passed amongst friends. 

Best wishes, 

Principal

ANNEXURE I 

AFFIDAVIT BY THE STUDENT 

On a Non-Judicial Stamp Paper of Rs.10/- 

1) I,------------ (full name of student with University Roll Number) 

s/o d/o Mr./Mrs./Ms. ___________________________________________ , having 

been admitted to ----------------------------------------(name of the institution) , have 

received a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher 

Educational Institutions, 2009, (hereinafter called the “Regulations”) carefully read and fully understood the provisions contained 

in the said Regulations. 

2) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging. 

3) I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the penal and 

administrative action that is liable to be taken against me in case I am found guilty of or abetting ragging, actively or passively, or 

being part of a conspiracy to promote ragging. 

4) I hereby solemnly aver and undertake that 

a) I will not indulge in any behaviour or act that may be constituted as ragging under clause 3 of the Regulations. 

b) I will not participate in or abet or propagate through any act of commission or omission that may be constituted as ragging 

under clause 3 of the Regulations. 

5) I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of the Regulations, 

without prejudice to any other criminal action that may be taken against me under any penal law or any law for the time being in 

force. 

6) I hereby declare that I have not been expelled or debarred from admission in any institution in the country on account of 

being found guilty of, abetting or being part of a conspiracy to promote, ragging; and further affirm that, in case the declaration is 

found to be untrue, I am aware that my admission is liable to be cancelled. 

Declared this ___day of __________ month of ______year. 

Name: 

________________ 

Signature of deponent 

VERIFICATION 

Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and nothing has 

been concealed or misstated therein. 

Verified at --------------(place) on this the ------(day) of -----------(month) , -----------(year ) . 

Solemnly affirmed and signed in my presence on this the -----------(day) of ---------------(month) , 

-------------(year ) after reading the contents of this affidavit. 

________________ 


OATH COMMISSIONER 

Note : It is mandatory to submit this affidavit in the above format, if you desire to register for the 

forthcoming academic session.


ANNEXURE II 

AFFIDAVIT BY PARENT/GUARDIAN 

1) I, Mr./Mrs./Ms. _____________________________________________________ (full 

name of parent/guardian) father/mother/guardian of , (full name of student with University Roll Number) , having been admitted 

to ____(name of the institution) , have received a copy of the UGC 

Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009, (hereinafter called the “Regulations”), 

carefully read and fully understood the provisions contained in the said Regulations. 

2) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging. 

3) I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the penal and 

administrative action that is liable to be taken against my ward in case he/she is found guilty of or abetting ragging, actively or 

passively, or being part of a conspiracy to promote ragging. 

4) I hereby solemnly aver and undertake that 

a) My ward will not indulge in any behavior or act that may be constituted as ragging under clause 3 of the Regulations. 

b) My ward will not participate in or abet or propagate through any act of commission or omission that may be constituted as 

ragging under clause 3 of the Regulations. 

5) I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to clause 9.1 of the 

Regulations, without prejudice to any other criminal action that may be taken against my ward under any penal law or any law for 

the time being in force. 

6) I hereby declare that my ward has not been expelled or debarred from admission in any institution in the country on 

account of being found guilty of, abetting or being part of a conspiracy to promote, ragging; and further affirm that, in case the 

declaration is found to be untrue, the admission of my ward is liable to be cancelled. 

Declared this ___day of __________ month of ______year. 

_____________________ 


Name: 

Address: 

Telephone/ Mobile No.: 

VERIFICATION 

Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and nothing has 

been concealed or misstated therein. 





forthcoming academic session. 

________________ 


OATH COMMISSIONER

ANNEXURE III 


AFFIDAVIT BY THE HOSTELLER 

Mr/Mrs/Ms……………………………………S/o/D/o/W/o…………………………Permanent 

address…………………………………………………………………..having been admitted to M.M.M. Engineering College, 

Gorakhpur, in B.Tech. ………..Branch ………Year……..Semester………resident of ……………Bhawan in Room No….....have 

received a copy of hostel and college rules & regulations, carefully read and fully understood the provisions contained in it. 

I hereby solemnly aver and undertake that: 

a) I (Student/Parent/Guardian) have received a copy of hostel rules & regulations and have read and understood everything 

clearly. I are signing the rules and regulations documents without any force or coercion from any side. 

b) I also agree to pay the hostel mess advance charges which are to be adjusted for future mess bills on receipt from the 

mess manager/mess secretary and also the rentals and establishment charges etc. shall be paid at the time of admission to 

the hostel. 

c) I will abide by the rules and regulations of this institute and hostels in totality as and when amended time to time by the 

college authorities. 

d) I hereby affirm that, if found guilty in disobeying the hostel and college rules & regulations, I will be liable for the 

punishment according to the college/hostel rules and regulations as decided by college discipline committee/Proctorial 

Board and dully approved by college Principal. 

e) I hereby declare that I have not been expelled or debarred from any institute in the country on account of being found 

guilty in any in disciplinary act. 

f) I also declare that if my conduct, during my stay in the hostel is found unsatisfactory, due to my negligence, misbehavior 

& indiscipline I will immediately vacate the hostel if ordered to do so. 

Declared this ……………….. day of …………………month of …………. Year 


Name: 

Address: 

Telephone/ Mobile No.: 

VERIFICATION 

Verified that the above contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and nothing 

has been concealed of misstated therein. 




________________ 


OATH COMMISSIONER 


forthcoming academic session.

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n'eksRrj Nk=o`fRr @ 'kqYd izfriwfrZ gsrq vkosnu i= 

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Nk=@Nk=k ds gLrk{kj 

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Proforma for Affidavit (Scholarship) 

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Application Form for NSS (2013-14) Application Form for NSS (2013-14) 

Registration No. 

Registration No. 

Serial No. 

National Service Scheme 

M.M.M. Engg. College, Gorakhpur 

Session-2012-13 

Name of School- M.M.M. Engg. College, Gorakhpur 

Name of Student: 

Father/Husband Name: 

Date of Birht: 

Sex(Male/Female): 

Caste: 

Class & branch 

Receipt No. of Admission Fee Submitted & Date 

Serial No. 

National Service Scheme 

M.M.M. Engg. College, Gorakhpur 

Session-2012-13 

Name of School- M.M.M. Engg. College, Gorakhpur 

Name of Student: 

Father/Husband Name: 

Date of Birht: 

Sex(Male/Female): 

Caste: 

Class & Branch 

Receipt No. of Admission Fee Submitted & Date 

Permanent Address 

Permanent Address 

Address for Correspond 

Address for Correspond 

Any past experience of Social Work 

Any past experience of Social Work 

Signature of Student Signature of Officer Signature of Student Signature of Officer 

Photo 

Photo

Madan Mohan Malaviya Engineering College, 

Gorakhpur -273010 (U.P.) 

Fees/Charges of B.Tech. First Year (New Admission Session 2013-2014) 

(The fee is tentative and is likely to be revised) 

Sl. No. 

Ist Year 

(A) College I Sem. (Rs.) II Sem. (Rs.) 

1 Tuition Fee* 40000 --- 

2 Registration/Admission Fee 100 100 

Total 40100 100 

(B) Hostel Charges 

1 Room rent 1800 1800 

2 Electricity & Water 2500 2500 

3 Electric Fan 125 125 

4 Utensil & Crockery 350 00 

5 Ward Boys & other Services 1800 1800 

6 Hostel Maintenance 650 650 

7 Hostel Caution Money 5000 00 

Total 12225 6875 

(C) Examination Charges 

1 University Exam 3000 --- 

2 Development Fee Univ. 250 --- 

3 Insurance 200 --- 

4 Enrollment 100 --- 

5 Degree Fee 00 --- 

Total 3550 --- 

(D) User Charges 

1 Recreation Fee 650 650 

2 Identity Card Fee 65 00 

3 College Day Fee 100 100 

4 Student Activities 650 650 

5 Bus Charges for Hostler (For Day Scholar) 900 (1800) 900 (1800) 

6 Magazine Fee 175 00 

7 Students Aid Fee 200 200 

8 Internet and Connectivity 1950 1950 

9 Computer & Stationary 250 250 

10 Training & Placement Fee 300 300 

11 Industrial Tour 00 00 

12 Exam. Contingencies 125 125 

13 Medical Fee 300 300 

14 Library Fee 250 250 

15 Laboratory Fee 500 500 

16 Book Bank 125 00 

Total for Hostetler ( Day Scholar) 6540 (7440) 6175 (7075) 

(E) Other Charges 

1 Caution Money (Library/W.S./Lab) 5000 --- 

2 Alumni Association Membership 1000 --- 

3 Information Brochure 150 --- 

4 Connectivity 250 

Total 6400 --- 

College Fee (Hostetler) 68815 13150 

College Fee (Day Scholar) 57490 7175 

(F) Additional Advance Charges( Hostetler ) 

1 Mess Advance Fee 12000 12000 

Total #12000 12000 

Grand Total amount (Hostetler) 80815 25150 

* Ist Year NRI candidate will pay tuition fees 7000 $ or its equivalent Indian currency, Rest fees will be as it is. 

# Mess fee should be deposited separately through mess challan only which are attached at the end of this 

document. For Boys Challan of Vishveswarya Bhawan and for girls challan for Sarojini Bhawan should be used. 

Dean Academics



Fees / Charges of B.Tech. Students (Lateral Entry for Diploma Holders/B.Sc. Graduates) directly admitted in IInd Year in Session 2013-2014 

Second Year (New Admission) 


Sl.No. 

II nd Year 

(A) College IIISem. (Rs.) IV Sem. (Rs.) 

1 Tuition Fee 40000 --- 


Total 40100 100 


1 Room rent 1800 1800 







Total 12225 6875 






5 Degree Fee --- --- 

Total 3550 --- 


















Total Hostetler (Day Scholar) 6540 (7440) 6175 (7075) 


1 Caution Money ( Library/W.S./Lab) 5000 --- 



4 Connectivity 250 --- 

Total 6400 



(F) Additional Advance Charges( Hostetler) 


Total 12000 12000 

Grand Total amount for Hostetler 80815 25150 

Dean Academics



Fees/Charges of M.C.A. First Year (New Admission) Session 2013-2014 


Sl.No. 

Ist Year 

(A) College Charges I Sem. (Rs.) II Sem. (Rs.) 



Total 25100 100 


1 Room rent 1800 1800 







Total 12225 6875 







Total 3550 --- 


















Total Hostetler ( Day Scholar) 6540 (7440) 6175 (7075) 





4. Connectivity 250 --- 

Total 6400 



(F) 

Additional Advance Charges( Hostetler) 


Total 12000 12000 

Total amount for Hosteler 65815 25150 

Dean Academics



Fees/Charges of M.B.A. First Year (New Admission) Session 2013-2014 


Sl.No. 

Ist Year 

(A) College Charges I Sem. (Rs.) II Sem. (Rs.) 



Total 50100 100 


1 Room rent 1800 1800 







Total 12225 6875 







Total 3550 --- 


















Total for Hostetler (For Day Scholar) 6540 (7440) 6175 (7075) 

(E) Other 




Connectivity Charges 250 --- 

Total 6400 

College Fee (Hostler) 78815 13150 


(F) 

Additional Advance Charges( Hostetler) 


Total 12000 12000 

Grand Total amount for Hostler 90815 25150 

Deam Academic

Care: Please enter Reg. No in the 

Description/Narration Column 

MMMEC, GORAKHPUR 

Semester Fee Deposite Challan 

(Power Jyoti Scheme) 

Collection Branch Copy 

State Bank of India ____________________Branch 

Account No: 31580851255 

“MMMEC Fee Account” 

SBI, MMMEC, Gorakhpur 

Process through Power Jyoti Scheme 

Reg No*: 

UPTU Roll No 

Name: 

Course: 

Branch: 

Semester: 

Particulars In Rupees 

Institute Fee: 

Institute Dues: 

Mess Fee: 

Mess Dues: 

Total Amount: 

Total amount One Hundred Only 

(in words) 

Bank Charge of Rupees 30/- only to be collected 

upfront by the Branch. 

Name Of the 

Remitter: 

Address: 

Contact No.: 

Sign of Remitter: 

Journal No.: 

Received the amount as per details mentioned above 








Account No: 31580851255 




Reg No*: 

UPTU Roll No 

Name: 

Course: 

Branch: 

Semester: 




Mess Fee: 

Mess Dues: 

Total Amount: 


(in words) 

Bank Charge of Rupees 30/- only to be 

collected upfront by the Branch. 

Name Of the 

Remitter: 

Address: 

Contact No.: 


Journal No.: 









Account No: 31580851255 




Reg No*: 

UPTU Roll No 

Name: 

Course: 

Branch: 

Semester: 




Mess Fee: 

Mess Dues: 

Total Amount: 


(in words) 

Bank Charge of Rupees 30/- only to be collected 

upfront by the Branch. 

Name Of the 

Remitter: 

Address: 

Contact No.: 


Journal No.: 


Signature of Receiver 

& Bank Acknowledgement Stamp 


& Bank Acknowledgement Stamp 


& Bank Acknowledgement Stamp

31858342846 

31858342846 31858342846

enu eksgu ekyoh; bathfu;fjax dkyst] xksj[kiqj - Madan Mohan Malviya ...

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