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Guru Jambheshwar University of Science and Technology, Hisar

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ANNEXURE-I

GURU JAMBHESHWAR UNIVERSITY OF SCIENCE AND TECHNOLOGY, HISAR


Examination Form for Re-appear and Improvement Candidates only
(Candidates are advised to use photocopy of this form for each course/semester separately and submit the same
along with the requisite fee and attested copy of result /DMC directly to the Controller of Examinations
G.J.U.S.&T. Hisar)
Regn.-cum-Roll No. …………..………………………………………………………………………….(To be filled by the candidate)
Application form for …………………………….Semester/Year of …………………………… Course for Jan/June 20………………. examination.
Name of Candidate : …………………………………………………………………………………
Space for
Father’s Name : ………………………………………………………………………………… Photo
(Attested)
Medium of Examination : …………………………………………………………………………………
Examination Centre 1. …………………………………. 2. …………………………………… 3. …………………………….
Subjects of Re-appear/Improvement Papers (Write Clearly the Nomenclature and Paper Code)
1. …………………………………. 2. …………………………………… 3. ……………………………………………
4. …………………………………. 5. …………………………………… 6. ……………………………………………
7. …………………………………. 8. …………………………………… 9. ……………………………………………
Last session in which candidate appeared and got re-appear …………………………………. Enrolment no. ………………………………………….
Session in which the candidate has passed the final examination (Improvement cases only):
............................................................................................................................................................................................................
Have you ever been disqualified by this or other University? If yes, give detail as below:
Examination ……………………………………………………… Semester………………………………………………….
Session…………………………………………. Fee Paid vide Bank Challan No. …………………………………. Date……………………………………….for
₹ ………………………………………
I solemnly declare that the particulars filled by me are correct and that in ca se of any discrepancy found therein, I shall be
responsible for the consequences.

Postal Address ………………………………………………………………………………………………………………………………………………………........................


E-mail……………………………………………………………………………Phone No. with STD Code/Mob. No.….......................................................
……………………………………………………………………………………………………………………………………………………………………………………………………..
Dated………………………………………………….. Signature of the Candidate ………………………………………………………….

GURU JAMBHESHWAR UNIVERSITY OF


SCIENCE AND TECHNOLOGY, HISAR
Provisional Roll no. Slip (only for Re-appear/improvement candidate)
Note: The candidate may be admitted to the Examination Hall on production of this slip for appearing in the following
examination.
Regn.-cum-Roll No.
Spa ce for
Name of Course / Exam…………………………………. Semester………………………………. for examination …………20……….
Photo
Name of Candidate ……………………………………………Father’s Name………………………………………………………………………
(Attes ted)
Signature of the Candidate……………………………………………………………… Centre of Exam………………………………………

Controller of Examinations
See overleaf

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ATTESTATION
I certify that the candidate ……………………………………………………………………………………..S/o /D/o

Sh.…………………………………………….. (a) is eligible to appear in the above examination; and

(b) the particulars filled in by him/her are correct.

Dated : …………………………………………… Signature of Dealing


with official seal

Note: The candidates are required to mention the address on the back side of Provisi onal Roll no. Slip.

--------------------------------------------------------------------------------------------------------------------------------------------------------------------
(TO BE FILLED BY THE CANDIDATE)
Regn.-cum-Roll No…………...………………………………………………………………Course…………………………………………….
Name: ……………………………………………………………………………………………………………………………………………………..
Father’sName: ……………………………………………………………………………………………………………………………………….
Address (Correspondence) : ……………………………………………………………………………………………

…………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………
PIN ……………………………………………………………..

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