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Gitam University Gitam University Gitam University Gitam University Gitam University

This document is an examination application form for GITAM University. It requests information from the applicant such as the program and branch they are applying for, semester/trimester, month and year of the examination, name, date of birth, gender, category, native place, parents' names, permanent and correspondence addresses, fee details, and a recent passport photo. The applicant must sign and date the form and submit it along with original bank documents and a photo copy of their SSC certificate. The head of the applicant's department must also sign to recommend or not recommend the applicant for issuing a hall ticket.

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naresh chowdary
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42 views1 page

Gitam University Gitam University Gitam University Gitam University Gitam University

This document is an examination application form for GITAM University. It requests information from the applicant such as the program and branch they are applying for, semester/trimester, month and year of the examination, name, date of birth, gender, category, native place, parents' names, permanent and correspondence addresses, fee details, and a recent passport photo. The applicant must sign and date the form and submit it along with original bank documents and a photo copy of their SSC certificate. The head of the applicant's department must also sign to recommend or not recommend the applicant for issuing a hall ticket.

Uploaded by

naresh chowdary
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GITAM UNIVERSITY GITAM UNIVERSITY GITAM UNIVERSITY GITAM UNIVERSITY GITAM UNIVERSITY

(Declared as Deemed to be University U/S 3 of UGC Act, 1956)


VISAKHAPATNAM530 045 (A.P.)
Examination Application Form
(Only for First Semester/Trimester and Supplementary cadidates)
Paste recent
passport size
photograph (to be
attested by the
Head of the
Department /
First year
Coordinator.
1. Examination Appearing for
(i) Program :.............................................................................
(ii) Branch : ......(iii) Branch Code
(iv) Semester/Trimester :................................. (v) Month & Year of the Examination :.........................
2. Name in full with surname as per SSC or equivalent (in capital letters)
4. Date of Birth 5. Sex: Male / Female
6. Category: SC/ST/OBC/Others 7. Native of Rual or Urban
7. Fathers Name
Mothers Name
8. Permanent address Address for correspondence
9. Fee: First Semester / Trimester candidates need not pay examination fee.
Fee for supplementary candidates:
one subject: Rs.300/- Two subjects: Rs.500/- Three or more subjects: Rs.750/-
Amount paid: Rs.....................; Rupees...........................................................................only (in words)
Name of the Bank: Challan / D.D. No.: Date:
Enclose: (i) Original bank challan/D.D. (ii) Photo copy of S.S.C. or equivalent certificate to the application
Date : Signature of the Candidate
For Office Use Only
Recommended for the issue of Hall Ticket subject to the candidate fulfilling all eligibility criteria.
Not recommended because ................................................................................................................
Signature of
Head of the Department
Regd. No.
Name Surname
Date Month Year
Pin: Pin:
email: contact number:

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