MANIPAL INSTITUTE OF TECHNOLOGY, MANIPAL

A Constituent Institute of Manipal University

EXAMINATION APPLICATION
B.E./B. Arch./M. Tech. /M.C.A. Degree Examination…………...200…
Regular/Repeater/Make-up
Sem. : Physics/Chemistry
( For 1st year B.E. only)

Branch : Section:

Reg.No.:

Name : Male/Female

Present Address: …………………………………. Father's Name: ………………………………………….

…………………………………………………………. Mother's Name: ………………………………………….
…………………………………………………………. Phone No: …………... ……………………………………
…………………………………………………………. Email: ………………………………………………………

SUBJECTS APPEARING (Regular students will appear for all subjects)

Code No. Subjects Code No. Subjects

Examination Fees Paid Rs. …………… Receipt No. …………… Date ………….………………….

I declare that the information given above is correct to the best of my knowledge and also I understand that
unless I fulfill the attendance and other requirements, I will not be eligible for appearing the examination.

…………………………………..
Date:
Signature of the Candidate

CERTIFICATE TO BE RECORDED BY THE HEAD OF THE INSTITUTION

1. Certified that the particulars given by the candidate have been verified and found correct.
2. Certified that the candidate is appearing for the examination as per existing rules and the attendance
and the progress of the candidate is satisfactory. Registration of the candidate for the examination is
recommended.
……………………
NOTE: Separate application form for each semester.
DIRECTOR

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MANIPAL INSTITUTE OF TECHNOLOGY, MANIPAL

A Constituent Institute of Manipal University

EXAMINATION ADMISSION TICKET

B.E./B.Arch./M. Tech./M.C.A. Degree Examination…………...200…

Regular/Repeater/Make-up
Sem. :

Stick Recent
Branch : Passport size
Photograph

Reg.No.:

Name :

SUBJECTS APPEARING (Regular students will appear for all subjects)

Code No. Subjects Code No. Subjects

Signature of the Candidate DIRECTOR