KRISHNA UNIVERSITY RAJUPETA, MACHILIPATNAM, KRISHNA DISTRICT (A.P)

Transcription

1 KRISHNA UNIVERSITY RAJUPETA, MACHILIPATNAM, KRISHNA DISTRICT 00 (A.P) Application Form for obtaining the Degree in Convocation / ABSENTIA for UG (B.A./B.Com./B.Sc./ B.Ed., BHM, BCA, BBM, LLB) PG (M.Pharm /MCA /MBA/M.Sc.,/M.A.,/MHRM/M.Ed/M.Com.) and Ph.D. Programmes (Strike off whichever is not applicable) U.G. P.G. Ph.D PHOTO Paste Your Recent Passport size Photograph (. X. cm) (Do not staple /Pin on photo. IN PERSON / BY POST. DUE DATE (FOR OFFICE USE ONLY) Signature of the Section In-charge PHOTO Paste Your Recent Passport size Photograph (. X. cm) (Do not staple /Pin on photo Name of the Candidate (In capital strictly as per the SSC records) Father s Name (In capital strictly as per the SSC records) Hall Ticket Number Name of the Programme Month & Year of Passing Class obtained (Consolidated Statement of Marks/ Consolidated Statement of Grades & Provisional Certificate ) Medium Sex Male/Female Full Address (In Capital Letters) Phone No. Cell No. Res.No. With STD Code FEE DETAILS NAME OF THE BANK D.D. NO. AMOUNT DATE NAME OF THE COURSE BEFORE CONVOCATION AFTER CONVOCATION AT THE TIME OF CONVOCATION Rs. /- Rs. /- Rs. / Cut here ACKNOWLEDGEMENT (to be filled by the candidate) Received application for Degree Certificate from Sri / Ms. H.T No Programme On D.D./ Challan No. Amount for Rs. /- Dated In Person / By Post Signature of the Receiver with Seal and Date

2 Name of the Examination Passed for which now you have applied B.A./ B.Com./ B.Sc./ B.Ed./ BHM/ BCA/ BBM /LLB / M.Pharm /MCA /MBA/M.Sc.,/M.A.,/MHRM/M.Ed/M.Com. (Please enclose attested copies of the Marks memos/grade Cards, Consolidated Statement of Marks/ Consolidated Statement of Grades & Provisional Certificate) NAME OF THE COURSE MARKS/GRADE SECURED IN I Year / Semester Papers II Year / Semester Papers III Year / Semester Papers IV Year / Semester Papers THEORY MARKS / GRADE Month & Year of Passing

3 0 V Year / Semester Papers 0 VI Semester Papers 0 VII Semester Papers 0 VIII SEMESTER PAPERS

4 0 IX SEMESTER PAPERS 0 X SEMESTER MODEL PAPERS 0 GRAND TOTAL MARKS / CGPA With Total Credits : Name of the Course (M.Phil/Ph.D.) : Name of the Department : Name of the faculty : Month & year of passing Pre-Ph.D./ : Pre-M.Phil/Part-I exam (enclose Xerox copy of Marks statement) Month & year of Notification :

5 DECLARATION BY THE CANDIDATE. I Solemnly promise and declare that if admitted to the Degree will in my daily life and conversation conduct myself so as to become a member of the University.. I sincerely promise and declare that to the best of my ability and opportunity I will use my powers for the furtherance of true learning.. I solemnly promise that I will faithfully and diligently fulfill the duties of the profession to which I eventually belong and that will on all occasions maintain its purity and reputation.. I request that my Degree Certificate may be issued to me in absentia. Date: Station: Signature of the Candidate Cut Here Address for Communication (In Capital Letters) Address for Communication (In Capital Letters) NAME : NAME : FATHER S NAME : FATHER S NAME : H.NO : H.NO : STREET / COLONY STREET / COLONY POST / VILLAGE POST / VILLAGE MANDAL/TOWN MANDAL/TOWN DIST. / STATE DIST. / STATE PINCODE PINCODE PHONE NO. PHONE NO. INSTRUCTIONS. Candidate should Affix Two () Passport size (. X. cm) photographs on the application in the place provided for the photographs (Do not staple or pin on the photos, small size photos will be rejected).. Students desirous of taking their degree in absentia have to fill in this form submit to the Controller of Examinations, Krishna University duly filled in accompanied by prescribed fee through a Demand Draft from any Nationalized bank drawn in favour of the Registrar, Krishna University.. The candidate is instructed to be very careful about the entries to be made in all the columns. All entries should be made in candidates own handwriting and he/she will be held personally responsible for any incorrect entry that he/ she makes. Signature of the candidate is compulsory on application.

6 CHECK LIST. Demand Draft for Rs. /- (Tick whichever is applicable). Two Passport size Photographs. Xerox copy of identity card.. Attested copy of S.S.C & Provisional / Degree Certificate of Qualifying Exam or its Equivalent exam.. Attested copy of Provisional certificate, Consolidated Statement of Marks/ Consolidated Statement of Grades and all semester Marks memos / Grade cards for which now you have applied for Degree Certificate. NOTE: Your Application will be rejected, If, you do not enclose any one of the above checklist.