NATIONAL INSTITUTE OF TECHNOLOGY, DURGAPUR DURGAPUR, WEST BENGAL, INDIA

______________SEMESTER REGISTRATION FORM 20____ - 20______ Name (IN BLOCK LETTER) : Roll No. : Programme : Hostel/Local Address : Mobile No. : Courses undertaken (including elective courses) : Sl. No. Course Code E-Mail : Branch : Registration No. :

Course Name

Payment of Institute Fees Amount paid : Date of Payment :

Mode of Payment : (Attach copy of the payment slip and fine slip, if any) Date : Verified by Signature of the student

Dealing Assistant

Assistant Registrar(Academic)