Guru Jambheshwar University of Science & Technology, Hisar Examination Form For Re-Appear, Improvement and Mercy Chance Candidates Only

GURU JAMBHESHWAR UNIVERSITY OF SCIENCE &
TECHNOLOGY, HISAR
EXAMINATION FORM FOR RE-APPEAR, IMPROVEMENT
AND MERCY CHANCE CANDIDATES ONLY
(Candidates are advised to use photocopy of this form for each course/ programme/
Semester separately and submit the same alongwith the requisite fee and attested copy
of result/ DMC directly to the Controller of Examinations G.J.U.S.&T., Hisar)
Roll No.-cum-Enrolment No………………………….(to be filled by the candidate)
Application form for…………………Semester/ Year of………… Course

for January/ June, 20………examination.
Space for
Name of Candidate : ……………………… photo
Father’s Name : ………………………. (Attested)
Medium of Examination:…………………………..
Examination Centre 1…………………2……………….3…………………..
Subjects of Re-appear/ Improvement Papers (Write Clearly the Nomenclature and
Paper Code.)
1…………………….. 2……………………. 3……………………..
4……………………… 5………………….. 6………………………
7……………………….. 8……………………..9………………………
Last session in which candidate appeared and got re-appear……………..

Enrolment no…………………….. Institute………………………………………
Session in which the candidate has passed the final examination (Improvement cases
only):……………………………………………………………………………..
Have you ever been disqualified by this or other University? If Yes, give detail as below:
Examination……………………Semester…………………..Session…………………
Have you applied for re-evaluation ? If yes, give detail as below:

Examination………………….semester………………session…………………..
Fee paid vide University Receipt No./ DD No………………….Date…………….
for Rs……………………
I solemnly declare that the particulars filled by me are correct and that in case of any
discrepancy found therein, I shall be responsible for the consequences and my
candidature be treated as cancelled.
Postal Address………………………………………………………………………………
…………………………………………………………………………………………………
E-mail ID…………………………………Phone No. with STD Code/ Mob. No…………..
……………………………………………………………………………………………….
Dated………………….. Signature of the Candidate

……………………………………………………………………………………………………
GURU JAMBHESHWAR UNIVERSITY OF SCIENCE & TECHNOLOGY, HISAR

Provisional Roll No. slip (only for Re-appear/ Improvement and Mercy chance candidates)
Note: The candidate may be admitted to the Examination Hall on production of this slip
for appearing in the following examination.
Roll no. cum Enrolment No.

Space for
Photo
Name of Course/ Exam……………… Semester……………… of
examination……………….20…..
Name of Candidate…………….. Father’s Name…………………………….
Signature of the Candidate…………….Centre of Exam……………………..
Controller of Examinations
ATTESTATION
I certify that the candidate…………………………S/O D/O Sh………………………

(a) bears a good moral character.
(b) is eligible to appear in the above examination; and
( c) Has signed the Examination Forms in my presence and the particulars
filled in by him/her are correct.
Dated:…………… Signature of the Chairperson/

Principal-Director
With official seal.
Note: The candidates are required to mention the address on the back side of
Provisional Roll no. slip.
(TO BE FILLED BY THE CANDIDATE)

Roll-cum-enrolment no……………………………Course…………………………
Name :………………………………………………………………………………..
Father’s Name…………………………………………………………………………
Address (Correspondence)…………………………………………………………
………………………………………………………..
…………………………………………………………
………………………………………………………….
Pin……………………………………….

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GURU JAMBHESHWAR UNIVERSITY OF SCIENCE &

Roll No.-cum-Enrolment No………………………….(to be filled by the candidate)

Application form for…………………Semester/ Year of………… Course

Last session in which candidate appeared and got re-appear……………..

Have you applied for re-evaluation ? If yes, give detail as below:

Dated………………….. Signature of the Candidate

GURU JAMBHESHWAR UNIVERSITY OF SCIENCE & TECHNOLOGY, HISAR

Roll no. cum Enrolment No.

Name of Candidate…………….. Father’s Name…………………………….

Signature of the Candidate…………….Centre of Exam……………………..

I certify that the candidate…………………………S/O D/O Sh………………………

Dated:…………… Signature of the Chairperson/

(TO BE FILLED BY THE CANDIDATE)

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