APPLICATION FORM FOR INTERNET CONNECTION (FOR …

1 APPLICATION form FOR INTERNET CONNECTION (FOR HOSTEL & COLLEGE CAMPUS) Session: .. 1. Name of Student :_____ 2. Father s Name :_____ 3. Permanent Address :_____ 4. Local Address :_____ 5. Hostel Address :_____ 6. Mobile No. :_____ 7. Email Address :_____ 8. Class (Year / Semester) :_____ 9. College / Institute :_____ 10. Type of System : Laptop Desktop Tablet Mobile 11. (MAC Address of System) :_____ I will be abide by information Technology (IT) Act 2000 (21 of 2000) and amended rules of information Technology (IT) Act 2008 (10 of 2008) for Misuse/illegal activities.

2 Signature of student with date The student named .. of year .. may be permitted to have INTERNET CONNECTION in the hostel up (date of disconnection of INTERNET account) The APPLICATION is forwarded to Officer Incharge, INTERNET Cell for further necessary action. (Hostel Warden) (Incharge, INTERNET Cell) (ADSW) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ For Official use only Address allotted User Id Password Created on.

3 AMC Engineer Dealing Asstt Officer Incharge ACCEPTANCE LETTER To, The Officer Incharge INTERNET Cell SKN College of Agriculture Jobner Sir, studying in .. (Class & Year) and I am user of the INTERNET service being provided by SKN College of Agriculture, Jobner. I assure you that neither I will be involved in misuse/illegal use of this service nor I will be involved in any unauthorized person s activities to use it and I will maintain the security of the system.

4 I will be abiding rules and regulations framed by Information Technology (IT) Act 2000 (21 of 2000) and amended rules of Information Technology (IT) Act 2008 (10 of 2008) for misuse/illegal activities. Signature Name: .. Class: .. Phone/Mobile No.: .. Forwarded: Head of the Department/Advisor