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    Khallikote University, Berhampur, Ganjam

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    BIPIN KUMAR MUDULI
    This document is an application form for a 6th semester undergraduate examination from Khallikote University in Berhampur, India. It contains details about the student Podili Mohan such as his registered number, roll number, stream, subjects, address, declaration, and instructions. The form needs to be properly filled and submitted along with documents and fees. It certifies that the student's particulars are correct, he has the required attendance and qualifies for the exam as per university regulations.

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    Khallikote University, Berhampur, Ganjam

    Uploaded by

    BIPIN KUMAR MUDULI
    34 views2 pages
    This document is an application form for a 6th semester undergraduate examination from Khallikote University in Berhampur, India. It contains details about the student Podili Mohan such as his registered number, roll number, stream, subjects, address, declaration, and instructions. The form needs to be properly filled and submitted along with documents and fees. It certifies that the student's particulars are correct, he has the required attendance and qualifies for the exam as per university regulations.

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    Mohan

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    This document is an application form for a 6th semester undergraduate examination from Khallikote University in Berhampur, India. It contains details about the student Podili Mohan such as his registered number, roll number, stream, subjects, address, declaration, and instructions. The form needs to be properly filled and submitted along with documents and fees. It certifies that the student's particulars are correct, he has the required attendance and qualifies for the exam as per university regulations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views2 pages

    Khallikote University, Berhampur, Ganjam

    Uploaded by

    BIPIN KUMAR MUDULI
    This document is an application form for a 6th semester undergraduate examination from Khallikote University in Berhampur, India. It contains details about the student Podili Mohan such as his registered number, roll number, stream, subjects, address, declaration, and instructions. The form needs to be properly filled and submitted along with documents and fees. It certifies that the student's particulars are correct, he has the required attendance and qualifies for the exam as per university regulations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    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

    Print

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