COCHIN UNIVERSITY OF SCIENCE AND TECHNOLOGY

APPLICATION FOR REVALUATION OF ANSWER BOOKS

(Please see instructions overleaf) 1 Name of the Candidate in Block Letters (As entered in the Mark List)

2. Sex 3. Details of Examination i. Name of the Examination ii. Month and year of the Examination iii. Branch iv. Register Number of the Candidate v. Centre of Examination vi. Date of publication of result 4. Details of papers to be revalued Sl. No. 1. 2. 3. 4. 5. 6. 7. 8. Title of the paper(s) & Subject Code (as in the Mark List) Marks Secured Maximum Marks Space for Office use

5. (i) (ii) (iii) (iv)

Details of fees paid: (see Instruction No.6 ) Rs. Amount of fees paid (in figures) If remitted in Cash at University Cash Counter, Cash Receipt reference (copy Receipt No: of Receipt to be enclosed) If remitted by Demand Draft, Demand Draft reference (see Instruction No.6 - DD No: IMPORTANT) If remitted by Chalan Dated: Dated:

No.Dated

6.

Address for communication (in block letters & PINCODE to be compulsorily indicated) Contact references: (i) Landline (ii) Mobile No. STD code: (iii) Email address No:

Name of the Candidate : Signature Place: Date : :