|:SIDDHARTH UNIVERSITY KAPILVASTU, SIDDHARTH NAGAR

Teacher Registration for Examinership (For Teachers of Siddharth University Campus & It's Affiliated Colleges Only)
(Annual/ Semester Examination)

PERSONAL DETAILS


Required! Name : *
Required! Father's Name :*
Required! Mother's Name :*
Gender :*
Required! Date of Birth (DD/MM/YYYY) :*
Phone No. (with STD code) :
Required! Mobile No. :*
Required! Email ID :*	A@A.com
Required! Residential Address :* (District and Pin Code)
Required! Aadhar Number :*
Required! PAN :*
Required! Bank Name :*
Required! Bank Branch Name :*
Required! Bank A/C Number :*
Required! IFSC Code :*

INSTITUTIONAL DETAILS

Required!

Required! Faculty :*

Required! Required! Name of college (District) :*

Required! Department :*

Required! Nature of College :*

Required! Specilization 1 :*

Required! Post Held :*

Required! Specilization 2 :

Required! Nature of Appointment :*

Required! Specilization 3 :

**Required! Date of Appointment :***
**Required! Date of Confirmation :***

**Required! Approval from the University (Letter No.):***
**Required! Approval from the University(Date):***

Required! Approval from Directorate of Higher Education (Letter No.) (For Permanent Teachers of Degree Colleges):*
Required! Approval from Directorate of Higher Education (Date) (For Permanent Teachers of Degree Colleges) :*

Required! Date of Retirement (For Retired Teachers Only) :*
Required! Name of college Retired from (For Retired Teachers Only) :*

Required! Experience of Teaching UG Classes :*

(in Years)

Required! Experience of Teaching PG Classes :*

(in Years)

ATTACHMENTS

	Note : Upload Image (size below 1 MB) Only (.jpg \|.jpeg\|.png .gif)

Latest Photograph : *	*
Signature : *	*
Copy of Aadhar Card : *	*
Copy of PAN Card : *	*
Teacher Approval/Appointment Letter issued by University : *	*
Teacher Approval Letter from Directorate of Higher Education (For Permanent Teachers of Degree Colleges) : *	*
Experience Letter of Teaching issued by the Principal/HOD/Registrar : *	*
Proof of Retirement (For Retired Teachers Only) : *	*

Confirmation:

The above information as filled in by me are correct to the best of my knowledge and I bear all responsibility thereto.' in place of 'Above information which is provided by me is true, and i responsible for that.

Note: * Fields are Mandatory

Instructions:

Kindly Save the Registration Form and take Printout, get it verified from College Principal and submit in the office of the Registrar. A Card bearing an Unique Teacher’s Code will be issued to the Teacher.

Teacher Registration for Examinership (For Teachers of Siddharth University Campus & It's Affiliated Colleges Only) (Annual/ Semester Examination)

Teacher Registration for Examinership (For Teachers of Siddharth University Campus & It's Affiliated Colleges Only)
(Annual/ Semester Examination)