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Proxy Registration Form For Students

The document is a student registration form for proxy internet access at Banaras Hindu University. It contains details of the student like name, enrollment number, course of study, date of birth. It also contains the student's declaration that they will use the internet access responsibly and for academic purposes only. The form is signed by the student and declarations are also provided by the head of the student's department and warden of their hostel, if applicable. The student is assigned the proxy username "603.9792378336" upon completion of the registration process.

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vishal
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997 views1 page

Proxy Registration Form For Students

The document is a student registration form for proxy internet access at Banaras Hindu University. It contains details of the student like name, enrollment number, course of study, date of birth. It also contains the student's declaration that they will use the internet access responsibly and for academic purposes only. The form is signed by the student and declarations are also provided by the head of the student's department and warden of their hostel, if applicable. The student is assigned the proxy username "603.9792378336" upon completion of the registration process.

Uploaded by

vishal
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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Students Registration Form http://14.139.41.52/ldapadmin/student/do_studentReg_test.

php

Proxy Registration Form for Students


Name of the Applicant : Mr. VISHAL KUMAR SIDDHARTH
Date of Birth : 13/03/2000 Paste Your
Enrollment Number : 9792378336 Self Attested
Course Studying : BA(HONS.) Photograph
Institute/Faculty/Unit : Faculty of Social Science
Department : Faculty of Social Science
Whether Hostelar : yes Hostel Name : Acharya Narendra Deo Hostel
Date of Course Completion : 01/04/2022
Whether Research Scholar : no
Old Login Id :
Mobile Number : 6390319903
Nationality : Indian
Email ID : wish568359@gmail.com
Your Proxy Username is "603.9792378336" (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: 10/08/2019
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 : 603.9792378336
PROXY SERVER : ___________________________
The above Proxy ID is allotted for the period upto:

1 of 1 10-Aug-19, 1:11 PM

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