KALASALINGAM Anand Nagar, Krishnankoil – 626 126

Srivilliputtur (via), Virudhunagar (DT)

Academy of Research and Education
Tamilnadu, INDIA.
DEEMED TO BE UNIVERSITY Ph: 04563-289300
Estd.U/S 3 of UGC Act 1956, Accredited by NAAC with “A” Grade
e-mail : coe@klu.ac.in
www.kalasalingam.ac.in │1800 425 7884 │1800 425 9395

OFFICE OF THE CONTROLLER OF EXAMINATIONS

APPLICATION FOR CHANGE OF NAME

1. Name of the Student …

2. Register Number …

3. Date of Birth …

4. Year / Branch of Study …

5. Father’s Name …

6. Changed Name (in Capital) …

(+2 Mark Sheet xerox copy / Government Gazette
Copy must be submitted) – If change the name
in previous semester grade cards fine Rs.100/-
(each card) should be paid)

Signature of the Signature of

Candidate Coordinator Signature of HoD

Date:

FOR OFFICE USE ONLY

Cash Receipt No. ----

Entered by (Staff Signature with name) ----

Date: