Application for College ID cum Library Card

Sir,                                                
I request to kindly issue Student Identity cum Library Card for which I am furnishing the following details for all official purposes.
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Email *
Name : *
Date of birth *
MM
/
DD
/
YYYY
Father's Name: *
Mother's name: *
Address ( For correspondence): *
Permanent Address : *
Phone No:  *
Course: *
Required
School (Discipline) : *
Required
Blood Group:  *
Required
I, hereby , declare that the information furnished above is true to my knowledge and belief.


 Forwarded by School In-charge                                                       (Signature)
N.B. :(i) The passport size photograph for the ID card will be taken at the time of printing of this form in the College Library.    
(ii) The duly signed form is to be  submitted to the Academic Cell, College of Post Graduate Studies in Agricultural Sciences, (Central Agricultural University , Imphal) , Umiam. 
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