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    General Purpose Form New Modified

    Uploaded by

    Kiran Christopher
    The document appears to be an application form for various certificate requests from the University of Kerala, such as mark lists, transcripts, and attestations. It lists the various certificate types available, corresponding fees, and required enclosures depending on the request. The form requires applicants to provide personal details and the specific certificate needed, and includes a declaration to be signed.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    General Purpose Form New Modified

    Uploaded by

    Kiran Christopher
    438 views2 pages
    The document appears to be an application form for various certificate requests from the University of Kerala, such as mark lists, transcripts, and attestations. It lists the various certificate types available, corresponding fees, and required enclosures depending on the request. The form requires applicants to provide personal details and the specific certificate needed, and includes a declaration to be signed.

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    Kerala University

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    The document appears to be an application form for various certificate requests from the University of Kerala, such as mark lists, transcripts, and attestations. It lists the various certificate types available, corresponding fees, and required enclosures depending on the request. The form requires applicants to provide personal details and the specific certificate needed, and includes a declaration to be signed.

    Copyright:

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

    General Purpose Form New Modified

    Uploaded by

    Kiran Christopher
    The document appears to be an application form for various certificate requests from the University of Kerala, such as mark lists, transcripts, and attestations. It lists the various certificate types available, corresponding fees, and required enclosures depending on the request. The form requires applicants to provide personal details and the specific certificate needed, and includes a declaration to be signed.

    Copyright:

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

    Sl. No. UNIVERSITY OF KERALA G. E. P.

    APPLICATION FORM (FOR GENERAL & EXAMINATION PURPOSES ) Rs. 20/- (Twenty)

    Details of Fee remittance (Add Rs. 10/- as service charge if payment is made For office use only
    through Demand Draft and Rs. 20/- if the application form is downloaded from website.)

    Pay-in-slip/DD No..........................dt................................Amount Rs................

    (........................................................................................................................)

    remitted at University Cash counter / Friends Janasevakendram/

    Bank.................................................................................................................

    1. Name of Applicant (in block letters) : ...............................................................................................................................................

    2. Date of Birth : .......................................................................................... Male / Female...............................

    3. Address with Phone No. (in block letters) : ...............................................................................................................................................

    ...............................................................................................................................................

    4. PIN (Permanent Identity Number) : ...............................................................................................................................................

    5. RANK CERTIFICATE / OFFICIAL TRANSCRIPT / TRANSCRIPT OF MARKS / ATTESTATION OF MARK LIST / ATTESTATION OF
    SYLLABUS / ATTESTATION OF DEGREE CERTIFICATE / DETAILED MARK LIST / CONFIDENTIAL MARK LIST /
    ADDITIONAL MARKLIST / CANCELLATION OF EXAMINATION / CANCELLATION OF PRIVATE REGISTRATION / DUPLICATE
    DEGREE CERTIFICATE / DUPLICATE HALL TICKET / DUPLICATE PRIVATE REGISTRATION MEMO / DUPLICATE
    REVALUATION MEMO / CERTIFICATES ON MEDIUM OF INSTRUCTION, DURATION OF COURSE, DETAILS OF COURSE / PERCENTAGE
    CERTIFICATE / PHOTOSTAT COPY OF ANSWER BOOK ETC.....
    Purpose (write specifically the requirement)
    as mentioned in / No. 5 above.

    Name of the Course

    Subject/Branch/Group

    Annual Scheme/ Semester


    Regular / Pvt. study / IDE

    Examination Centre/ College

    Reg. No. / Candidate Code


    Month & Year of Passing

    Additional Details

    DECLARATION
    I do hereby declare that the above particulars are true and correct to the best of my knowledge and belief.

    Place :

    Date : Signature of the Applicant.


    Fee rates as on 1-10-2016. Confirm current fee rates before remittance of the same

    Encl. required Requirement Purpose Fee (Rs.) Remarks


    1.4 Confidential marklist Higher Studies First Copy 100
    -do- Each Additional Copy 50
    Employment Each Copy 200
    1.2.3 Additional Marklist All courses Each 50 + Search Fee (if applicable)**
    1.2.3 Detailed Marklist Per part/Semester/Year 50 Per part+Search Fee (if applicable)**
    1.3.12 Rank Certificate (First Rank fee exempted) 100
    1.3.8.12 Official Transcript 250
    1.2.3 Pre-Degree Marklist 800 Year (94 Admission Onward)
    1.3.12 Attestation of Marklist/PreDegree pass certificate 1000 Per Copy
    1.3.12 Attestation of Degree/Diploma/Certificate 1000 Per Copy
    1.3.14.12 Exam. transcript (Proforma/Questionnaire) 1000 Per Copy
    1.3.16.17 Duplicate Hall ticket 50 (PG. Course 75/-)
    1.3.6.11 Cancellation of Examination (to be applied within 14 days of the last day of exam. attended 50 Per each written paper
    1.3 Cancellation of Pre-Degree Exam. (Filled up application to be endorsed by Principal of the College) 1000
    1.3.9.11.18 Cancellation of Exam. and Private Regn. 1000 Only if registered/appeared for exam.
    1.3.9.11.18 Course cancellation for joining another University 500
    1.3.15 Duplicate Private Registration Memo 250
    1.3.9.10/13 Cancellation of Private registration/unavailed portion without registering for exam. 500
    1.3 B.Tech. detailed Marklist / B.Tech. Percentage Certificate 500
    1.3 Special Certificate-Pre-Degree 500
    1.2.3 Pre-Degree Addl. Marklist 800
    1.3.5.7 Pre-Degree Pass Certificate (1996-2006) 500
    1.3.5.7 ,, (1957-1979) 1500
    1.3.5.7 ,, (1980-1995) 1000
    1.3.5.7 Duplicate Degree Certificate / Diploma Certificate (If original has lost irrecoverably) 1000 + search fee if applicable*
    1.3.5.7 Triplicate Degree Certificate Rs. 1250 + Search fee*
    1.3.20 Duplicate Degree / Diploma (Original Certificate is torn/mutilated or defaced
    but name and Register No. is intact 1000 + search fee if applicable*
    1.3. Duplicate Re-valuation Memo 250
    1.3.12 Special Certificate 250
    * Search fee - upto1 year Nil, 1 year to 5 years Rs. 130/- and after 5 years Rs. 500
    ** Search fee - upto1 year Nil, 1 year to 5 years Rs. 50/- upto 10 years Rs. 100/- after 10 years Rs. 200
    List of Enclosures
    1. Original Cash Receipt/DD for the fee remitted. DD must be drawn in favour of The Finance Officer, University of Kerala, Payable at Thiruvananthapuram.
    Name of the applicant and purpose should be written on the reverse side of the DD. Postal orders / Money Orders will not be accepted.
    2. Self Addressed Sufficiently Stamped envelope to send articles by ordinary post.
    3. Self Addressed sufficiently stamped envelope to send the documents by Registered / Speed post.
    4. Sufficiently stamped (Registered Post) envelope with the address of the institution where the Confidential Marklist is to be sent. Separate envelope for each institution.
    Reference, if any, must be superscribed.
    5. An affidavit by the applicant on a stamp paper of Rs. 100/- duly attested by a Notary Public/ First Class Judical Magistrate stating among other facts, that the
    original certificate already issued, the circumstances under which it has been lost and that it has been irrecoverably lost. If it is recovered in future, the duplicate
    being issued now shall be surrendered back to the University of Kerala.
    6. Recommendation of the Principal/Chief Superintendent of the Examination Centre for cancellation of Examination. (written papers including practicals)
    7. Course Certificate from the Principal of the college last studied (for Regular college study candidates)/Identification certificate from a Gazetted Officer (for Private
    Study candidates)
    8. Attested copies of documents (S. S. L. C./X/XII certificate/Transfer Certificate) to prove date of birth.
    9. Original Transfer Certificate and Original qualifying Certificates/Marklists.
    10. Affidavit of the candidate on stamp paper worth Rs. 100/- stating that the original private Registration memo issued, has been irrecoverably lost and that he / she has
    not been registered for the exam, attested by Notary Public/First Class Judicial Magistrate.
    11. Original hall ticket (attested copy for partial cancellation) 16. Original qualifying certificates
    12. Photocopy of Marklist and Certificates 17. Hall ticket form duly filled in duplicate
    13. Original Private Registration Memo 18. Original Marklist/Certificate issued
    14. Sufficient number (+one copy) of proforma/questionnaire 19. Photocopy of the marklists and certificates
    15. Private Registration form dully filled in 20. Remaining portion of torn, mutilated or defaced
    original certificate but name and Reg. No. is intact.
    APPLY TO
    I. For Certificate / Services relating to Academic matters.
    The Registrar, University of Kerala, Thiruvananthapuram for Attestation of documents, Special Certificates
    II For other services relating to Examinations.
    The Deputy Registrar, Exams III, Private Registration / Matriculation / Migration Pre Degree & B.Com. Degree Exams. (Annual Exams.)
    The Deputy Registrar, Exams I B.A./B.Sc. B.Com.Degree exams. (Annual Scheme)
    The Deputy Registrar, Exams IV M.A./M.Sc./M. Com./MSW / M. Phil. B.Ed./M.Ed./P & IDE Exams.
    The Deputy Registrar, Exams VI All Prof. courses including B. Tech & M.Tech./MBA & B.A./B.Sc./B.Com. (Restructured/Vocational/Semester
    courses)
    Office address : University of Kerala, Palayam, Thiruvananthapuram - 695034 Website www.keralauniversity.ac.inEnquiry 0471- 2305994 / 2386228
    kup 403/2016-17 20,000

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