Professional Documents
Culture Documents
Ksou Form Sem-Year
Ksou Form Sem-Year
OPEN UNIVERSITY
Appl
No.
Programmes 2014-2015
Roll Number :
Name : .......
2.
Father/Husband Name :
3.
4.
5.
Karnataka
Other State
SEX: M/ F
7. NATIONALITY :
8.
Indian
Non Indian
Pin : ..
9.
CONTACT NUMBERS
SC
ST
PHY. CHALLENGE
OBC
GENERAL
DEFENCE
EX. SERVICEMAN
12.
14.
15.
Subject Code
Examination Passed
16.
Subject/Paper Name
Board/University
%Of Marks
Marks
obtained
Class
Obtained
17.
S.No
Branch of remittance : .
Name of the Bank:
Total
Declaration by the Candidate: I acknowledge to have fully read the prospectus and certify that I have understood
all the provisions indicated therein. I certify that I am qualified for the Programme as indicated in the prospectus.
I hereby certify that all particulars stated by me in application are true to the best of my knowledge and belief.
I understand that my admission is liable to be cancelled if I suppress or distort any information furnished in my
application. I understand that University reserves the right to modify/ delete the syllabi, Programme structure,
rules and regulations, as and when required. I understand fees once paid will not be refunded. I understand
that the University reserves the right to cancel the admission without assigning any reason.
Place:
Date:
Specimen signature
1.
2.
Study Centre
I certify that I have personally verified the original certificates and the attached documents including DDs.
I certify that the candidate fulfill the eligibility criteria as per Admission Qualification norms prescribed in the
prospectus. I shall be held responsible for any kind of litigation with regards to services.
Place:
Date :
Signature of Co-ordinator
AUT
Programme eligibility (Programme/Semester)..
Checked by .Verified By ...
KSOU
Programme eligibility (Programme/Semester)
Checked by Verified By
Note: 1. Candidates are required to attach the following documents with this
form:
a)
b)
Crossed DDs
c)
Identity Card (Duly filled & photograph pasted by the candidate) and attested by Study Centre co-ordinator.
d)
Candidates are advised to collect the candidate Copy of the Receipt for Admission from the Centre.