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Documents Year of Admission

KARNATAKA STATE OPEN UNIVERSITY
MANASAGANGOTRI, MYSORE - 570 006
APPLICATION FOR EXAMINATION

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ROLL / I.D. CARD NO.

M.Sc ....................................................................... / MBA- First / Second / Third / Fourth Semester

Note: i ) Please read carefully the instructions given overleaf before filling up the application, as well as instruction in the prospectus. ii) Strike off whichever is not applicable.

Affix Stamp Size Photo here

Mobile No:....................................................
Name of the Examination Centre 1. Name of the Candidate (in block letters):
(as in qualifying examination records)

Landline No:..................................................

Email ID:........................................................

2. Permanent Postal Address with pin code (in block letters) Pin Code: 3. Subjects / Papers for which to appear - (compulsorily indicate Reg. No., Year and Month of passing the previous examinations, if any) (P for assed, A for appearing)
A/P Subjects / Paper (First Semester) Year & Month A/P Subjects / Paper (Second Semester) Year & Month
Karnataka State Open University, Mysore Name of the Bank & Place of Remittance ....................................................... Name of the Course M. Sc .............../MBA Class : I/II/III/IV Sem Roll No:

KSOU-500-EXAMINATION FUND SBM-54035420128 SBI-31106997538

A/P

Subjects / Paper (Third Semester)

Year & Month

Subjects / Paper (Fourth Semester)

Name and Address of the Student

Note: Fees once paid will not be Refunded.

Date:

K
Signature of the Remitter For the use of the Bank The Amount of Rupees (in words)............................ has been received / Challan No. Date & Bank Seal Signature of the Officer receiving the money UNIVERSITY COPY Not to be seperated from the Form

5. do you belong to (mark(a) to which you belong

S.C

S.T

Cat I

Cat IIA

Cat IIB

Cat IIIA

Cat IIIB

G.M.

PH

6. Sex: Male / Female

7. Medium: English

Karnataka State Open University, Mysore Name of the Bank & Place of Remittance ....................................................... Name of the Course M. Sc .............../MBA Roll No: Class : I/II/III/IV Sem

Karnataka State Open University, Mysore Name of the Bank & Place of Remittance ....................................................... Name of the Course M. Sc .............../MBA Roll No:

Class : I/II/III/IV Sem Name of the Course M. Sc .............../MBA Roll No:

SO U
UD

Code No: Amount Rs. 501: Examination Fee : Penal Fee : Change of Centre Fee : Total Amount (in words) Rupees .......................................

C O PY
T CO PY

ORIGINAL SBM, Manasagangotri, Mysore - 06 SBI, New Sayyaji Rao Road, Mysore-01

Karnataka State Open University, Mysore Name of the Bank & Place of Remittance .......................................................

Class : I/II/III/IV Sem

C O PY

KSOU-500-EXAMINATION FUND SBM-54035420128 SBI-31106997538

Duplic ate SBM, Manasagangotri, Mysore - 06 SBI, New Sayyaji Rao Road, Mysore-01

KSOU-500-EXAMINATION FUND KSOU-500-EXAMINATION FUND SBM-54035420128 SBI-31106997538 SBM-54035420128 SBI-31106997538

Triplicate SBM, Manasagangotri, Mysore - 06 SBI, New Sayyaji Rao Road, Mysore-01 Quadruplic ate SBM, Manasagangotri, Mysore - 06 SBI, New Sayyaji Rao Road, Mysore-01

C O PY

Y SO R E

Name and Address of the Student

Name and Address of the Student

Name and Address of the Student

BA N K

SB M /S BI ,M

Note: Fees once paid will not be Refunded. Date: Signature of the Remitter For the use of the Bank The Amount of Rupees (in words)............................ has been received / Challan No. Date & Signature of the Officer Bank Seal receiving the money To be retained with the receiving bank

Note: Fees once paid will not be Refunded. Date: Signature of the Remitter

Note: Fees once paid will not be Refunded. Date: Signature of the Remitter For the use of the Bank The Amount of Rupees (in words)................................................ has been received / Challan No. Date & Signature of the Officer Bank Seal receiving the money Student copy to be retained by the student. No seperate receipt will be issued

For the use of the Bank

The Amount of Rupees (in words)................................................. has been received / Challan No. Date & Signature of the Officer Bank Seal receiving the money Receiving Bank should send this copy to the Finance Officer, KSOU, Manasagangotri, Mysore-06

ST

Code No: Amount Rs. 501: Examination Fee : Penal Fee : Change of Centre Fee : Total Amount (in words) Rupees .......................................

Code No: Amount Rs. 501: Examination Fee : Penal Fee : Change of Centre Fee : Total Amount (in words) Rupees .......................................

Code No: Amount Rs. 501: Examination Fee : Penal Fee : Change of Centre Fee : Total Amount (in words) Rupees .......................................

EN

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Documents
9. Details of fees paid: Year I Semester II Semester III Semester IV Semester Amount Paid Name of the Bank Challan No. Date

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I declare that the above information furnished by me is correct to the best of my knowledge. Date........................... ............................................. Place.......................... Signature of the Candidate FOR OFFICE USE ONLY

Accepted / Rejected
............................

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

Scrutinized by
IMPORTANT INSTRUCTIONS TO BE FOLLOWED BY THE CANDIDATES 01. 02. Regarding the submission of filled-in application form, read the instructions printed in the exam fee circular and in prospectus.

Checked by

The Examination fee paid Challan in the application along with Admission fee paid photocopy challan should be submitted on or before the due date (without or with penal fee as prescribed). Otherwise, the application will not be registered for examination. Incomplete applications are liable to be rejected. Challan number etc. should be written in the application form in the space provided above. Examination fees once paid will NOT be re-adjusted / nor refunded under any circumstances. Regarding the rates of examination fees, separate circular is enclosed and also in the prospectus. For all instructions pertaining to examination Dates, Centres, Assignments, Time table, Announcement of Result. Convocation Dates etc., please see the KSOU website: www.ksoumysore.edu.in KSOU website is updated continuosly. Kindly enter the website often to get complete and recent information regarding the examination. Place in which examination will be held shall be notified 25 days prior to examination in the KSOU website. KSOU shall make all efforts to reach the students through post. However, KSOU is not responsible for postal delay. The filled-in application should be submitted to The Registrar (Evaluation)., Karnataka State Open University, Manasagangotri, Mysore - 570 006, within the stipulated date.

03. 04. 05. 06. 07.

08. 09.

10. 11.

MOBILE PHONES ARE PROHIBITED IN THE EXAMINATION HALL.