KUVEMPU

UNIVERSITY

JNANA SAHYADRI, SHANKARAGHATTA-577451 SHIMOGA DISTRICT, KARNATAKA

Directorate of Distance Education

BSc.(IT) / MSc.(IT) REGISTRATION FORM FOR REPEATERS
Note: 1) Please carefully read the information given at the back of this Form before filling up. 2) Fill up all details correctly & legibly.

1) Name of the Applicant

(In block letters as registered by KU)

: :

2) Roll No / Register No
(As given by KU)

3) Name of the Study Centre / Place

: : :

Study Centre code

4) Address for Communication

Telephone No.

5) Subjects / Papers for Repeaters Registration Course: BSc. (IT) / MSc.(IT)

(Tick whichever is applicable & Strike out whichever is not applicable)

Month & Year of Exam:

SL. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 Semester Subject Code Name of Subject/Exam

(in which appearing) Fees (Refer instructions)

Important : Please attach Xerox copy of Marks Card(s) with attestation.

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7) Fees to be paid by D.D Payable to Finance Officer . Kuvempu University SHANKARAGHATTA For (State Bank D.Ds) or SHIMOGA (for other Scheduled Banks) Name of Bank/Place DD No. Date Amount

I declare that the information furnished by me is correct. Enclosures: (1) DD

(2) Marks Card (Xerox/original)

Place: Date:

Signature of the Student