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Proxy Registration Form For Students

This document is a proxy registration form for a student named Vishal Rai. It provides his personal details like name, date of birth, course of study, and contact information. It also assigns him the proxy username "508.384962" and contains an undertaking where he agrees to use the university's IT resources responsibly and for academic purposes only. Signatures from the head of his department and warden of his hostel certify that he is a regular student.

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Shubharan
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119 views

Proxy Registration Form For Students

This document is a proxy registration form for a student named Vishal Rai. It provides his personal details like name, date of birth, course of study, and contact information. It also assigns him the proxy username "508.384962" and contains an undertaking where he agrees to use the university's IT resources responsibly and for academic purposes only. Signatures from the head of his department and warden of his hostel certify that he is a regular student.

Uploaded by

Shubharan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Proxy Registration Form for Students

Name of the Applicant :   Mr. Vishal Rai


Date of Birth : 09/08/1999 Paste Your
Enrollment Number : 384962 Self Attested
Course Studying : M.COM Photograph
Institute/Faculty/Unit : Faculty of Commerce
Department : Commerce
Whether Hostelar : yes Hostel Name : Dr. I.N. Gurtu Hostel
Date of Course Completion : 30/06/2021
Whether Research Scholar : no
Old Login Id :
Mobile Number : 9919463294
Nationality : Indian
Email ID : vhrai905@gmail.com
Your Proxy Username is "508.384962" (KINDLY NOTE IT DOWN)

Undertaking :

1. I shall be responsible for all the transaction from my ID.


2. I will be responsible for all the content browsing using the ID allotted to me.
3. I understand that IT infrastructure of the B.H.U is for academic use. Also, I shall not misuse it and I will take due care of any
misuses that might harm others in any means and/or may be otherwise considered objectionable or illegal as per Indian
Cyber Laws. In any such cases of misuses I do take full responsibility of it.
4. I will not intrude on privacy of anyone.
5. I understand that the IT Resources provided to me are subject to monitoring to the legal or law enforcement. I authorize
B.H.U Administration & Computer Centre to perform network vulnerability and scans over my ID, as and when needed for
protecting the overall Integrity and efficiency of the B.H.U. Network.
6. I understand that any use of IT infrastructure that constitutes a violation of the University Regulations could result in
administrative or disciplinary procedures.
7. I WILL ABIDE BY ALL THE ABOVE UNDERTAKINGS WITHOUT FAIL.

Date: 04/08/2019
Place:Varanasi (Signature of the Applicant)

Declaration by The Head/Dean of the Department

This is to Certify that is a regular student of our Department/Faculty and he/she needs an Internet proxy ID for his/her studies.

Date: Signature of the Head/Dean


Place: Varanasi (With Office Seal)       

Declaration by The Warden/Admin Warden of the Hostel

(Applicable for only those students who resides at B.H.U. Hostels)

This is to Certify that is a resident of the . He/She needs an Internet proxy ID for his/her studies.

Date:
Signature of the Warden/Admin Warden
Place: Varanasi
(With office Seal)       
RECEIPT
has been assigned the following Proxy ID :

USER ID : 508.384962
PROXY SERVER : ___________________________
The above Proxy ID is allotted for the period upto:

Date:
Signature               
Place: Varanasi

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