APPLICATION FOR REVALUATION Date: To The Controller of Examinations, Thro HOD, _________________ Sir, I request you to revalue my answer

script/s for the following subject/s relating to the Examinations held in________ (Month) _______ (year). 1. 2. 3. 4. University Registration No:: Full Name VTU ID No Branch
Sl. No. Sub Code

:: :: ::
Subject Sem. Marks Secured

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 I enclose DD. NO::________________ DD Amount_____________ Date_____________ at 750/- for Revaluation per subject. Forwarded to COE.

Signature of the HOD

Signature of the Candidate