Application form - Kuvempu University - Directorate of Distance ...

KUVEMPU UNIVERSITY ù"Auà=jû aBjºa;oÇ^PO"ADMISSION REGISTRATION FORM - DIRECTORATE OF DISTANCE EDUCATIONApplication No.IMPORTANT INSTRUCTIONS : 1. The following information is to be filled in by the Applicant. Before you fill the form, you are advised to go through the instructions given in the Prospectus.2. Write all the particulars NEATLY in CAPITAL / BLOCK letters with DARK BLACK Ball Point Pen.3. Do not make any stray marks on the application. 4. Do not fold 5. Do not overwrite1 Name of the Candidate in CAPITAL BLOCK Letters2 Name of father in CAPITAL BLOCK Letters3. Sex Code4. Category Code5. PHC/VHC6. Medium 7. Nationality0 = Male1 = Female1 = SC 2 = ST3 = OBC 4 = GM1 = PHC2 = VHC1 = Kannada2 = English1 = Indian2 = Others8. SC Centre Code 9. Student Counselling Centre Name10. Date of Birth11. Subject Code12. Course 13. SubjectDD M M YYSpace for Photograph14. Occupation 15. Annual Income17. Admission Registration / Examination Fees PaidAmount16. Language Codes (UG Courses)D.D.No / Receipt No.Photograph size should notexceed the size & this boxPaste one recent Stamp sizecolour photographPlease do not Pin or Staple.Use Quality Gum to Paste thePhotographDateDrawee BankSignature of the Candidate(Signature within the Box only)18. Complete Permanent Postal Address of the Candidate in CAPTIAL BLOCK LettersStatePin Code19. Telephone/Cell No.with STD Code20. E-mail21. Institution and University from whichthe qualifying examination is passed22. Qualifying Examination, if anyDegree / Pre UniversityMonth & Year of PassingSubjectClass23. List of Papers with Paper CodePaper CodeTitle of the PaperPaper CodeTitle of the Paper1.6.2.7.3.8.4.9.5. 10.24. Exam to Appear Reason, if skipping first Exam1 = Passed2 = Lateral Entry3 = Migration Signature of Candidate

DECLARATIONI hereby solemnly and sincerely affirm that the statements made and information furnished in my application and also in theenclosures 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 isover, fee shall not be refunded by the University. In case of any grievances, I shall approach the University and in case of anyarbitration and any redressal of grivences I shall abide by the arbitration and territorial jurisdiction clause laid in the prospectus.Place :Date :Signature of the ApplicantNote :Candidates should send the filled up Application to the Director, DDE, Kuvempu UniversityJnana Sahyadri, Shankaraghatta - 577 451, Shimoga District, Karnataka along with the DDtowards the Course Fee & relavant documents.