KHALLIKOTE UNIVERSITY, BERHAMPUR, GANJAM KU

APPLICATION FORM FOR UG EXAMINATION - 6th Semester (Back/Improvment) 2019

Khallikote University UG

COLLEGE NAME: Government Science College Chatrapur

EXAM ROLL NO: 041501EN002
REGISTRATION DATE: 25-03-2019
CLASS ROLL: CBA15-095
STREAM: ARTS
REGD. NO:
CORE: English
STUDENT NAME: PODILI MOHAN
SEMESTER: 6th Semester Back/Improvment
MOTHER'S NAME: TULASI PODILI
MOBILE NO: 9777054435
FATHER'S NAME: BHASKAR PODILI
EMAIL ID: babu9778138066@gmail.com
ADDRESS FOR CORRESPONDENCE
SUBJECTS DETAILS
At/Po: CHADHEIMARA
         
City: BERHAMPUR
CORE-13: ENGLISH-13
Dist: GANJAM
CORE-14: ENGLISH-14
State: Odisha
DSE-III : Research Methodology
Pin: 761100
DSE-IV: Project Work
Country:

Declaration: I do hereby declare that the particulars given above are true to the best of my knowledge and belief.

Certified that       Full Signature of the Candidate

1. The particulars given by the candidate are correct.

2. I have verified his/her certificates in original of the qualifying examination and the registration slip.
3. His/her conduct has been good and has studied diligently.
4. He/she has the required percentage of attandence and the candidate qualifies for the examination as per the regulation.
5. I know nothing against his/her moral character.

Signature of the
    Signature of Verifying Officer               Signature of Head
Principal

INSTRUCTIONS

1. No application shall be entertained unless it is properly filled in and submitted along with necessary documents in
conformity with the regulations and instructions of the university/college as amended from time to time.
2. No candidate shall be allowed to offer any subject or paper other than those mentioned in this application provided the
candidate is eligible under the Regulation to offer such subject or paper.
3. No application for admission to the examination shall be entertained after the due date.In exceptional cases permission may
be granted provided the reason fir delay is considered to be sufficent and reasonable and the application along with the
requisite fee(Tatkal mode) must reache the office on or before seven days of commencement of the examination .
4. Application forms duly not filled in will be rejected at any stage of detection.
5. The candidate is responsible for the address and phone no provided for all future correspondance regarding the exam.

Please Tick The Fee Which is Applicable

1.Examination fee 280 5.Squad fee 100 9.Computer Laboratory Fee 50
2.Central Valuation fee 150 6.fee for Mark sheet 50 10.Late fee 100
3.Center Charge 100 7.Fee for Provisional Certificate 0 11.Tatkal seva 1000
4.Registration fee 50 8.Laboratory fee for practicals 50       TOTAL:

FOR CASH COUNTER

Amount collected Rs :
Rupees:
Reciept No: Date:
Dealing
Assistant

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