KUVEMPU UNIVERSITY

Requisition for the issue of Duplicate/Consolidated /Correction Marks Card,

Provisional Pass/ Rank /Duplicate Degree/ Certificate etc.,

Note: 1. Strike off whichever is not applicable.

2. Separate applications must be used for each year. (i.e. 1st year, 2nd year and 3rd year
etc.,)
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1. Name of the Candidate with Complete
Postal Address (in Block Letters)

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2. (a) Duplicate Marks Card

(b) Consolidated Marks Card

(c) Provisional Pass Certificate

(d) Duplicate Degree Certificate

(e) Rank Certificate

(f) Correction of Marks Cards.

(g) Any other Certificate

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3. Name of the Degree.

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4. Register Numbers with Year and Month
of Passing the above degree
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5. Name of the Institution Studied.

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6. Details of Amount paid: D.D.No:
The prescribed fee may be remitted through Date:
Demand Draft drawn on SBM in favor of
“FINANCE OFFICER, KUVEMPU UNIVERSITY”
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Signature of the Candidate

Application submitted by Mr./ Mrs._________________________ for ___________________

has been scrutinized and forwarded with all relevant enclosures and D.D No._______________
Dt._______________ Rs. ______________ to your office for needful.