RAJKIYA ENGINEERING COLLEGE
AMBEDKARNAGAR U.P. 224122
WI-FI INTERNET REGISTRATION FORM
Read the Instructions before filling the form
• Fill up the form in Capital letters only.
• The complete Wi-Fi application forms are to be submitted in Server Room IT Department
• The account creation may take up to two days from date of receipt of application.
• In case of misuse, the account may be closed without any notice. The college may initiate
disciplinary actions against you as deemed appropriate.
• The account is subject to maximum data transfer limits as per the College policy.
Name:.......................................................................................................... Paste Your
Father’s Name............................................................................................ Recent Passport
Applicant Category(Tick anyone) : Student/ Employee/ Faculty Size Photograph
Branch: ........................................ Year: ...................................
University Roll No.:....................................... Registration No..........................................
Mobile No:........................................................ MAC Address.(12 digit): ...........................................
E-Mail Address: ...............................................................................................................................................
Local Address .................................................................................................................................................
...............................................................................................................................................................................
Declaration: I hereby declare that, the above information furnished by me is correct to the best
of my knowledge. I further undertake that I will use the Wi-Fi facility for Official/Academic
purpose only. I understand that any misuse of account may lead to actions against me as
determined suitable by the College.
Date.................... .... Signature of Applicant
Forward By
Sign Sign
(Head of Department) (In-charge CWN)
Student Name: ...........................................................Roll No.: .....................................................
For Office Use Only
User Name ................................................ User ID................
Password...................................................
Sign
(In-charge CWN)
