TRIPURA UNIVERSITY
(A Central University)
Suryamaninagar- 799022
CENTRAL LIBRARY
MEMBERSHIP FORM FOR STUDENT.
Name (in capital letters): ..………………………………………………………… Paste your
recent
Gender:………………………...…………………………………………………… Passport size
Father’s Name: …………………………………………………………………….. color
photograph
Department: ………………………………………………………………………...
Courses: …………………………………………………………………………….
Year of Admission:……………………………….. Session: ………………….........................................
Enrolment No:………………..………………………………………………………………………........
Category (UR/SC/ST/OBC/PWD):……………………………………………………………..................
Communication Address: …………………………………………………………………………………
……………………………………………..………………………………………………........................
Dist./City:………………………………………State:…………………………PIN:………………….....
Permanent Address: ………………………………………………………………………………………
…………………………………………….……………………………………………………………….
Nearest Police Station:…………………………………………………………………………………….
Dist./City:…………………………………………….State:………………………PIN:……….………...
Mobile No.: …………………………….Email ID: …………..………………………………………......
DECLARATION
I hereby declare that the information furnished above is true and correct to the best of my knowledge
and further declare that I will abide by the rules and regulations of the Central Library,
Tripura University, which may be made applicable from time to time.
Recomendaed by HoD
Signature of the Applicant
HoD
Date:……………………... Signature with Seal
Documents Required:
Copy of University I.D. Card / Pay-In-Slip
Copy of Address Proof (Aadhaar Card /Voter ID Card, etc.)
...................................................................................................................................................................
FOR OFFICE USE ONLY
Membership No: ............................
No. of Books Allotted:…………….
Date of Activation:………………..
PA/SPA/LA Assistant Librarian Librarian
Membership Section Membership Section (i/c)