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CENTRAL UNIVERSITY OF SOUTH BIHAR
APPLICATION FORM FOR PROVISIONALLY PROMOTED STUDENT
TO APPEAR IN END TERM EXAMINATION OF BACKLOG COURSES /
TO REPEAT BACKLOG COURSES IN NEXT SEMSTER
(1) NAME OF THE STUDENT :.....................................................................................................................(2) PROGRAMME:.................................................................................
(3) SEMESTER :.................................................(3)ENROLMENT NO. :.............................................................................(5) SESSION :....................................................................
DETAILS OF BACKLOG COURSES :-
Sl Course code Course title Attendance Appeared in previous Not appeared in end Name of the Course Signature of the Course
% in course end semester semester examination Instructor Instructor
examination of due to shortage of
courses attendance
Yes No Yes No
1

Payment of Fee on account of appearing in end term examination of backlog courses / to repeat the backlog courses :-
Particulars Nos. of Backlog courses Backlog Courses Fee Total Amount
Backlog Courses to be appeared in end semester Rs.2000/-
Backlog Courses to be repeated in upcoming semester Rs.3000/-
Semester Fee of the programme for repeat the semester
Gross Total Rs.

_________________
Date :................. Signature of Student
 Verification by Signature of the Concerned
Dealing Hand of the Signature of Dealing Hand of Signature of the Head of Department
Particulars
concerned Concerned Department Student's Mentor
Department
Previous Result of Backlog Courses
Attendance % in Backlog Courses
Applicable Fee for Backlog Courses

For Office Use Only

Account Section
Fee verification
Total Amount UTR No./Transaction No. Date of Payment Verified by Account Section

Examination Section

The student is allowed to appear in the end term examination of backlog courses / to repeat the backlog courses as mentioned at Sl. No...............& .......

Dealing Assistant Section officer Deputy Registrar Controller of Examinations

(Academic/Exam. Section) (Academic/Exam. Section) (Academic Section)