Computer Center Helpline

Proxy Registration Form - Special Case

Name of the Applicant*	:	Mr Ms Mrs
Date of Birth* (dd/mm/yyyy)	:
Employee ID/Any Unique ID*	:
Designation*	:
Faculty/Organization/Unit*	:	Select Faculty/Organization Academic Staff CollegeBharat Kala BhawanBHU PressCenter for Study of Soc. Exclu. and Inclu. PolicyCentral Discovery CentreCentral Hindu Boys,SchoolCentral Hindu Girls,SchoolCentral LibraryCentral Office Chief Proctor OfficeComputer Centre Controller Office DACEEWSSFaculty Guest HouseFaculty of ArtsFaculty of AyurvedaFaculty of CommerceFaculty of Dental ScienceFaculty of EducationFaculty of LAWFaculty of Modern MedicineFaculty of Performing ArtsFaculty of Sanskrit Vidya Dharma VigyanFaculty of Social ScienceFaculty of Veterinary and Animal SciencesFaculty of Visual ArtsGanga Research Indian Institute of Technology (IIT BHU)Institute of Agriculture ScienceInstitute of Environment and Sustainable DevelopmentInstitute of Management StudiesInstitute of Medical ScienceInstitute of ScienceInternational CentreKendriya Vidyalaya BHULD Guest HouseMahila Maha Vidyalaya (MMV)Malaviya Shishu BiharMalviya BhawanMalviya Ethic CentreN.C.C. (BHU)OtherOthersProctor OfficePublic Relation OfficeRajiv Gandhi South CampusRanveer Sanskrit VidyalayaSanitary and Support ServicesSchool of NursingShopping Centre ComplexSir Sunderlal HospitalStaff Health CentreStudent Health CentreStudent Welfare CentreTrauma CentreUddyan Vishesagya IkaiUniversity Employment Information BureauUniversity Guest HouseUniversity Sports BoardUniversity Works DepartmentVadic Vigyan Kendra
Department*	:
Date Until Required* (dd/mm/yyyy)	:
Specify Old Login Id (If Any)	:
Mobile Number*	:
Nationality*	:	Indian Forigner
Email ID*	:
Your "Login-USERNAME" for Proxy will be generated automatically after submitting this form
Enter Password* (Don't use Upper Case or Special Character)	:
Retype the Password*	: