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    International Centre For Distance Education and Open Learning Himachal Pradesh University, Summer Hill, Shimla-5

    Uploaded by

    ashish thakur
    This document is an application form for a student to take a regular examination. It requests information such as the student's name, father's name, registration number, date of birth, subjects to be examined, and previous examination results. It also requires certificates if the student belongs to a reserved category or has a disability. The form must be signed by the student and certified by an attesting authority from the International Centre for Distance Education and Open Learning to verify the student's eligibility and fee payment.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    International Centre For Distance Education and Open Learning Himachal Pradesh University, Summer Hill, Shimla-5

    Uploaded by

    ashish thakur
    58 views3 pages
    This document is an application form for a student to take a regular examination. It requests information such as the student's name, father's name, registration number, date of birth, subjects to be examined, and previous examination results. It also requires certificates if the student belongs to a reserved category or has a disability. The form must be signed by the student and certified by an attesting authority from the International Centre for Distance Education and Open Learning to verify the student's eligibility and fee payment.

    Original Description:

    DE-11

    Original Title

    DE-11

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    This document is an application form for a student to take a regular examination. It requests information such as the student's name, father's name, registration number, date of birth, subjects to be examined, and previous examination results. It also requires certificates if the student belongs to a reserved category or has a disability. The form must be signed by the student and certified by an attesting authority from the International Centre for Distance Education and Open Learning to verify the student's eligibility and fee payment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    58 views3 pages

    International Centre For Distance Education and Open Learning Himachal Pradesh University, Summer Hill, Shimla-5

    Uploaded by

    ashish thakur
    This document is an application form for a student to take a regular examination. It requests information such as the student's name, father's name, registration number, date of birth, subjects to be examined, and previous examination results. It also requires certificates if the student belongs to a reserved category or has a disability. The form must be signed by the student and certified by an attesting authority from the International Centre for Distance Education and Open Learning to verify the student's eligibility and fee payment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    DE-11

    International Centre for Distance Education and Open Learning


    Himachal Pradesh University, Summer Hill, Shimla-5

    APPLICATION FOR REGULAR EXAMINATION

    ICDEOL Roll No ............................ Examination Roll No................................


    Class ........................................ Academic Session ...............................
    1. Examination in which appearing .........................................................................................
    2. Examination centre 1 .......................... 2............................. 3.................................
    (In order of preference)
    3. Name of the candidate (in English) .................................................Male/Female...............
    (In block letters)
    (in Hindi) ............................................................................................................................
    4. Fathers Name : (in English) ...............................................................................................
    (In block letters)
    (in Hindi) ..............................................................................................................................
    5. Registration number ............................................................................................................
    6. Date of birth (figures & words) ...........................................................................................
    7. Do you belong to SC/ST/OBC/BC Yes/No (attach certificate)
    8. Are you blind/handicapped Yes/No (attach certificate)
    9. Particulars of the lower examination passed:

    Sr. Examination Year Roll Subjects Max. Percentage Result Remarks


    No Board/University No Marks

    10. Are you simultaneously appearing in compartment/re-appear subjects?


    if yes, mention name of the examination .............................. subjects ..............................
    Roll No ....................
    11. Subject(s) / course (s) in which to appear in the examination
    1 ...................................................................................
    2 ...................................................................................
    3 ...................................................................................
    4 ...................................................................................
    Medium .....................................

    12. Have you ever been disqualified by any board/university in any examination?
    if yes : give detail........................Class ................. Roll No ................. year .......................
    13. Permanent home address ............................................................................................

    14. Correspondence address ................................................................................................

    ................................................................................................

    15. Particulars of fee deposited: IPOs/B.D./University receipt No.................

    dated ................... amount ..................................................................

    16. State to which you belong .................................................................................................

    I solemnly declare that the particulars given above are correct and that in case of any
    discrepancy. I shall be responsible for the consequences.

    Signature of the candidate

    CERTIFICATE

    1. Certified that the candidate has passed .......................................form ..............................


    University or any other examination recognised equivalent thereto by the university.
    2. The candidate has remained on the role of the ICDEOL for academic year/session
    preceding the examination.
    3. The candidate has answered 75% of the assignments and has obtained not less than
    33% marks there in to earn eligibility to appear in the examination.
    4. The candidate has attended the personal contact programme prescribed for the course.
    5. The candidate bears a good moral character and that the statement made by him/her in
    this form is correct as per record of the ICDEOL.
    6 The fee of the candidate has been remitted and his/her name has been included in the
    statement of fee.

    Signature with Stamp of attesting authority


    International Centre for Distance
    Dated.................................. Education & Open Learning
    HIMACHAL PRADESH UNIVERSITY, SUMMER -HILL, SHIMlA-171005
    Roll No.....................................
    (To be assigned by the office)
    The candidate will be admitted to the examination hall on production and delivery of this Roll
    No. slip
    (To be filled in by the candidate)

    Admit(name of the candidate) ...........................................................


    Son/Daughter of Shri ........................................................................
    Space for photograph
    (duly attested) for all to the class/Subject/Semester/Year (................................................)
    candidates
    to be held in ...................................on the dates as given in the date
    sheet at Centre of Examination.

    Signature of the candidate................................ Controller of Exams.


    Himachal Pradesh University

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