Hall Ticket No:

College Code

JAWAHARLAL NEHRU TECHNOLOGICAL UNIVERSITY : KAKINADA KAKINADA !"" ##" A$%$&I'dia( A%%LICATION )OR AWARD O) DEGREE &To *e +e't to t,e Co't-olle- o. E/a0i'atio'+1 JNTUK1 Kaki'ada
D$D$ No: 2a'k: I' Co'4ocatio' &i' A*+e'tia( %-e Co'4ocatio' &Tick 567 t,e a88-o8-iate *o/ Dt$: A0o3't R+$:

!"" ##"$

A..i/ a -ece't %a++8o-t Si:e %,otog-a8,

%o+t9 Co'4ocatio'

Na0e i' 2lock Lette-+&As Per SSC(

)at,e-;+ 'a0e i' 2lock Lette-+

Add-e++ .oCo003'icatio' &Do 'ot -e8eat <o3- 'a0e(

Contact No:
Deg-ee to *e A=a-ded
Deg-ee 2-a'c,

%i' Code:

&To be filled in by the Office of the Controller of Examinations, JNTUK, Kakinada

T,e Ca'didate ,a+ .3l.illed all t,e acade0ic -e>3i-e0e't+ .o- t,e a=a-d o. Deg-ee i' $ T,e Ca'didate ,a+ +ec3-ed

Cla++ : Date :

CONTROLLER O) E?A@IANTIONS

!To be filled in by the Office of the "e#istrar, JNTUK, Kakinada(

A$ T,e a=a-d o. Deg-ee to t,e a88lica't =a+ e'do-+ed *< t,e Acade0ic Se'ate at it 0eeti'g ,eld o' B$ T,e E/ec3ti4e Co3'cil a88-o4ed t,e a=a-d o. Deg-ee to t,e a88lica't at it 0eeti'g ,eld o' "$ Deg-ee *ea-i'g '30*eCo'4ocatio' ,eld o' C$ De0a'd d-a.t+ e'te-ed i' t,e D$D$ Regi+te- at %age No$ !$ T,e Deg-ee ce-ti.icate 0a< *e i++3ed$ o' =a+ a=a-ded to t,e a88lica't at t,e

Date :

REGISTRAR

T,e Deg-ee Ce-ti.icate *ea-i'g No$

i+ Di+8atc,ed o'

Di+8atc,i'g Cle-k1 JNTUK1 Kaki'ada$

A..i/ o'e 0o-e %,otog-a8, ,e-e D W-ite t,e Hallticket No o' t,e *ack+ide o. %,otog-a8,

$O" POSTA% USE ON%&' %A(E%S $O" PE")ANENT A**"ESS !+rite in CAP,TA% %ETTE"S ON%&
Note: A+ <o3- Deg-ee =ill *e +e't *< 8o+t1 =-ite <o3- .3ll add-e++ 'eatl< a'd legi*l<$

-TNO NA)E $AT-E".S NA)E E)A,% ,* CONTACT NO

' ' ' ' '

A%T/ CONTACTNO ' A**"ESS '

P,NCO*E

'

9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999

$O" POSTA% USE ON%&' %A(E%S $O" PE")ANENT A**"ESS !+rite in CAP,TA% %ETTE"S ON%&
Note: A+ <o3- Deg-ee =ill *e +e't *< 8o+t1 =-ite <o3- .3ll add-e++ 'eatl< a'd legi*l<$

-TNO NA)E $AT-E".S NA)E E)A,% ,* CONTACT NO A%T/ CONTACTNO

' ' ' ' ' '

A**"ESS

'

P,NCO*E

'

%ist of co0ies to be enclosed to the a00lication for 0rocessin# O*

A$ DD i' .a4o3- o. the "e#istrar, JNTUK, Kakinada 8a<a*le at Kaki'ada$ &Na0e a'd H$T$ N30*e- +,all *e =-itte' o' t,e *ack +ide o. De0a'd d-a.t( )ee+ i'cl3+i4e o. %o+tage : a( I' Co'4ocatio' &I' A*+e'tia( ' "s 12334/ *( %-e9Co'4ocatio' : "s$ 5,2334/ c( %o+t Co'4ocatio' : "s6 1233E9 F & Late .ee o. R+$ !##E9 8e- e4e-< <ea-($

B$ "

?e-o/ co8ie+ o. SSC1 %-o4i+io'al ce-ti.icate$ a( ?e-o/ co8< o. C@@&.o- 2$Tec,E2$%,a-0ac< co3-+e+($ *( ?e-o/ co8ie+ o. t=o +e0e+te-+ 0a-k+ 0e0o .o- @$Tec,E@$%,a-0ac< co3-+e$ c( ?e-o/ co8ie+ o. .i4e +e0e+te-+ 0a-k+ 0e0o .o- @CA co3-+e$ d( ?e-o/ co8ie+ o. t,-ee +e0e+te-+ 0a-k+ 0e0o .o- @2A co3-+e$

C !$ G$ H$ J$

E'clo+e t7o 0ass0ort si8e 0hoto#ra0hs i' a +e8a-ate co4e- a'd 8i' t,e co4e- to t,e a88licatio'$ T,e H$T No +,o3ld *e i'4a-ia*l< =-itte' o' t,e *ack+ide o. t,e 8,otog-a8,+$ T,e St3de't Na0e a'd )at,e-+ Na0e i' t,e %-o4i+io'al ce-ti.icate 03+t *e =-itte' a+ 8e- SSC$ I. t,e-e i+ 0i+take i' t,e %CEC@@ co--ect i00ediatel< a'd e'clo+e t,e co--ected co8ie+$ I' ca+e t,e .illed a88licatio' =ill *< +e'd *< 8o+t$ %lea+e =-ite IOD9A%%LICATION I o' t,e to8 o. t,e co4e-$ I. t,e< .ail to .3l.ill a'< o. t,e -e>3i-e0e't+ +ti83lated a*o4e t,e OD A88licatio' =ill 'ot 8-oce++ed$

%lace : Date : SIGNATURE O) THE CANDIDATE