Reg.

No:

B3ENME7931

KANNUR UNIVERSITY

Combined I&II Semester B.Tech Degree (Supple./Improve.) Examinations,

April 2015
APPLICATION FORM
Passport Size

Photo(To be

Attested)
Signature of Identifying Officer with Seal
(To be signed on the Photograph)
Name and Designation
Signature of the Candidate.................................................
(To be signed in the Presence of Identifying Officer)

Name of Candidate

:RAHUL A S

Date of Birth

Sex

: MALE

Address

: ALLAKKOTT HOUSE,ONNAKKUNNU,

:1996-05-10

:KARIVELLUR , 670521
Phone

: 9567712228

Category

: OBC

Centre and Place of Examination :SADGURU SWAMY NITHYANANDA INSTITUTE OF TECHNOLOGY

Details of Paper Registerd

1

ENME7A107TH

BASIC MECHANICAL ENGINEERING(S)

ENME7A108TH

BASIC ELECTRICAL ENGINEERING(S)

ENME7A109TH

BASIC ELECTRONICS AND COMPUTER ENGINEERING(S)

Details of fee remitted

Amount

Chalan No.

540

10

Date of remittance

Name of Treasury

07-02-2015

SBT KANHANGAD

I hereby certify that the entries made above are correct to the best of my knowledge
Station :
Date :
Signature of Candidate
This is to certify that ......................................................... belongs to SC/ST/Other Backward/Forward Community
appearing for the examination for the First/Second Chance. His/Her Examination fees Rs.................will be claimed by
me from the District Harijan Welfare Officer concerned and the chalan for the same sent to the Controller of
Examinations at an early date.
Office Seal

Signature of the Principal

Address to which application is to be sent :

Controller of Examinations ,Kannur University , Thavakkara , Civil Station (P.O)-670 002