DIRECTORATE OF DISTANCE EDUCATION - Kuvempu University ...

KUVEMPU UNIVERSITYDIRECTORATE OF DISTANCE EDUCATIONOffice of the Director, Jnana Sahyadri, Shankaraghatta-577 451Shimoga District, Karnataka State, Phone: 08282 256450, 256246, 256426EXAMINATION APPLICATION FORM FOR REPEATERS-MAY/JUNE 2012(B.Sc (IT), M.Sc (IT) & B.Sc (ITIM)Affix a passportNote: 1) Please carefully read the information given at the back of this size photographform before filling upof the applicant2) Fill-up all details correctly & legibly.1 Name of the Applicant(in capitals as registered in KU)2 Roll/Registered Number(as assigned by University)3 Name of the Study CentrePlaceStudy Centre Code4 Address for CommunicationContact Number5 Course (put mark beside theappropriate course)6 Month & Year of Examinationappearing for7 Subjects/Papers appearing:SubjectSL SemesterCode1B.Sc(IT) M.Sc(IT) B.Sc(ITIM)Name of Subject/ PaperFee paid (referinstructions)2345678910Continued in page no.2

Page No.211121314Important: Please attach the Xerox copies of the marks card(s) of previous year(s)7 Fee paid in favour of “Finance Officer, Kuvempu University, Jnanasahyadri,Shankaraghatta” payable at State Bank of Mysore, Jnanasahyadri Branch or State Bank ofIndia, ShankaraghattaSL Name of Drawee Bank & Place DD Number Date Amount12“I declare that the above furnished information by me are correct”Signature of the ApplicantEnclosures: 1) DD:2) Xerox copies of the marks cards:Name of the Centre“Verified”Date: Seal of the Centre Signature of CoordinatorFor Office Use OnlyNumber of Subject:DD Amount:Registered byVerified by:Instructions to the Candidate1. The Examination fee for each subject for a repeater is Rs. 500/-, for two papers Rs.1000/-for three papers Rs. 1500/-, for four papers and above Rs.2000/-2. The examination fee is to be paid only through a DD which should be attached to theapplication and sent through the Study Centre to The Director, Directorate of DistanceEducation, Kuvempu University, Jnana Sahyadri, Shankaraghatta-577451.3. Fees once paid will not be refunded or readjusted4. Please enclose Xerox copy of your Marks Cards with attestation5. Last date for submission of exam applications (Repeater) is 28-04-2012 and with penalfee of Rs.500/- (Five hundred only) is 03-05-2012