Visvesvaraya Technological University

Examination Section,Belagavi 590 018.

Application for issue of CONSOLIDATED MARKS CARDS (CMC)
Name of the
Candidate

(in CAPITAL LETTERS)

USN

2
Old USN (if any)
CMC Fee: Rs.300/- per semester (Single DD in Favour of Finance Officer, VTU, Belagavi)

DD

Fees Paid
Details

ONLINE

No. : Bank:. Date:. .Amount:..

Attach Payment Receipt along
Payment Ref.No.:... Date:..Amount:..
with this Application

Marks Cards Particulars:

Semester

No. of

First Attempt

Grand Total

Attempts

Total

(Max)

Result

Semester

II

VI

III

VII

No. of

First Attempt

Grand Total

Attempts

Total

(Max)

Result

IV
Documents to be attached with application:
1. Xerox copies of the Marks Cards (self attested).
2. Single DD of requisite Fee drawn in Favour of Finance Officer, VTU, Belagavi.

Candidate shall indicate

Name: ...

the postal Address to

...

which CMC to be sent

...

(in CAPITAL LETTERS)

PIN:....
Country:Mobile: .. e-mail id:...

FOR OFFICE USE ONLY

Date: _ _ _ _ _ _ _ _ _ _
POST

Signature of the Candidate

PAYMENT DETAILS

B/H

DD No.:.... ONLINE Payment Ref.No.:........................................

Date:..Bank: Rs.:....
Sign Signature and Date:.

CMC No:.
Case Worker:________________ Special Officer:_______________ Registrar(Evaluation):____________________
Application will be rejected if address is not same in Block 5 and 6

......................................................................................................................................................................................................................................................................................

Candidate shall indicate

the postal Address to

Name: ...

which CMC to be sent

...

(in CAPITAL LETTERS)

...

USN

..PIN:..
Country: Mobile: . e-mail id: