KUVEMPU UNIVERSITY KUVEMPU UNIVERSITY KUVEMPU UNIVERSITY

Jnanasahyadri, Shankaraghatta, Shivamogga Jnanasahyadri, Shankaraghatta, Shivamogga Jnanasahyadri, Shankaraghatta, Shivamogga

Challan - Bank Copy Challan - DDE Copy Challan - Student Copy

A/C No. : 64100999567 / IFSC CODE: SBIN0040759 A/C No. : 64100999567 / IFSC CODE: SBIN0040759 A/C No. : 64100999567 / IFSC CODE: SBIN0040759

Bank State Bank of India Bank State Bank of India Bank State Bank of India
Branch Name JNANASAHYADRI Branch Name JNANASAHYADRI Branch Name JNANASAHYADRI
Branch Code 40759 Branch Code 40759 Branch Code 40759
Journal No Journal No Journal No
Date Date Date
Reference No: 10355010873 Reference No: 10355010873 Reference No: 10355010873
Register No: CO180062 Register No: CO180062 Register No: CO180062
Applicant Name: DEEPIKA S S Applicant Name: DEEPIKA S S Applicant Name: DEEPIKA S S
College / Degree: 5501 / MASTER OF COMMERCE II YEAR College / Degree: 5501 / MASTER OF COMMERCE II YEAR College / Degree: 5501 / MASTER OF COMMERCE II YEAR
Valid Upto : 00/00/0000 Valid Upto : 00/00/0000 Valid Upto : 00/00/0000
Fee: 7435/- Fee: 7435/- Fee: 7435/-
PAID TO THE CREDIT OF KUVEMPU UNIVERSITY, JNANASAHYADRI, PAID TO THE CREDIT OF KUVEMPU UNIVERSITY, JNANASAHYADRI, PAID TO THE CREDIT OF KUVEMPU UNIVERSITY, JNANASAHYADRI,
SHANKARAGHATTA SHANKARAGHATTA SHANKARAGHATTA
SHIVAMOGGA, SHIVAMOGGA, SHIVAMOGGA,
Particulars Course Fee Bank Charges Total Particulars Course Fee Bank Charges Total Particulars Course Fee Bank Charges Total
Amount Rs. 7435/- Rs. 50.00/- Rs. 7485/- Amount Rs. 7435/- Rs. 50.00/- Rs. 7485/- Amount Rs. 7435/- Rs. 50.00/- Rs. 7485/-
Rupees In Words : Seven Thousand Four Hundred and Eighty Five Only Rupees In Words : Seven Thousand Four Hundred and Eighty Five Only Rupees In Words : Seven Thousand Four Hundred and Eighty Five Only

Date Signature of Remitter Date Signature of Remitter Date Signature of Remitter

Received Rupees Received Rupees Received Rupees

Date & Seal Signature of Receiver Date & Seal Signature of Receiver Date & Seal Signature of Receiver
Denomination No.s Rs. Denomination No.s Rs. Denomination No.s Rs.
2000x 2000x 2000x
500x 500x 500x
100x 100x 100x
50x 50x 50x
20x 20x 20x
10x 10x 10x
Total Total Total
1. Collecting Branch has to enter Reference No: & Name of the candidate for this 1. Collecting Branch has to enter Reference No: & Name of the candidate for this 1. Collecting Branch has to enter Reference No: & Name of the candidate for this
transaction in core banking system transaction in core banking system transaction in core banking system
2. Not Transferable 2. Not Transferable 2. Not Transferable

10355010873 10355010873 10355010873

 KUVEMPU UNIVERSITY
DIRECTORATE OF DISTANCE EDUCATION

Application for Admission : MASTER OF COMMERCE II YEAR

Personal Details
Register No. CO180062
Application No 10355010873
Name DEEPIKA S S
Father Name SADASHIVA V

Date of Birth Gender Category Handicap

20/04/1994 Female GM NONE

Nationality Annual Income Occupation

INDIAN 120000 STUDENT

Address SP OFFICE OPP SHESHAGIRI COMPOUND SRI GANESHA

KRUPA, UDUPI TALUK UDUPI ,KARNATAKA - 576101
Mobile Landline Email
6361468125 - DEEPIKASS719@GMAIL.COM
Opted Course Details
Course MASTER OF COMMERCE II YEAR
Medium
Sl. No. Subjcet Name Sub. Short Name
1 BUSINESS ENVIRONMENT ANDPOLICY BEP
2 ENTREPRENEURIAL DEVELOPMENT ED
3 INTERNATIONAL BUSINESS IB
4 BUSINESS ETHICS ANDCORPORATE GOVERNANCE BEC
Contact Centre Details
Code Centre Name District
5501 KUDDE, SHANKARAGHATTA
Fee Details
Payment Mode Amount (Make the payment at the bank along with the challan and
SBM 7435 attach the challan copy while submitting application to the university)
Reference No 10355010873 Register No : CO180062
Payment Date UTR No Drawee Bank Bank Branch

Date :
Place : Signature of the Applicant

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 DECLARATION
I hereby solemnly and sincerely affirm that the statements made and information furnished in my application and also in the
enclosures submitted by me are true. Should it, however be found that the information furnished therein is not factually true, I
know that I am liable for prosecution and forfeiture of my admission. I have also taken note that once the admission process is
over, fee shall not be refunded by the university. In case of my grievances, I shall approach the university and in case of any
arbitration and any redressal of grievances I shall abide by the arbitration and territorial jurisdiction clause laid in the
prospectus.

Date :
Place : Signature of the Applicant

Note: Candidates should send the filled up Application to the Director, DDE, Kuvempu University, Jnana Sahyadri,
Shankaraghatta, Shivamogga, 577451 along with the Challan / Payment Acknowledgement (Net Banking) and Relevant
Documents.

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