VISVESVARAYA TECHNOLOGICAL UNIVERSITY, BELGAUM

APPLICATION FORM FOR B.E/B.Arch EXAMINATION 11 - 2011 R15411110747 ACK NO: 1 2 3 4 UNIVERSITY SEAT NO NAME OF THE CANDIDATE NAME OF THE FATHER/MOTHER SUBJECTS APPLIED
Subject Code
: :

1CR09EC071 RENJITH REGI REGI KOSHY

Sem 05

06AL51 06EC56

06EC52 06ECL57

06EC53 06ECL58

06EC54

06EC55

Payment Details

Mode of Payment : Cash 5 Fee paid in words Receipt No. with date
: :

Rupees Five Hundred Fifty Only

Penal Fee
Total Fee Amount (Rs.)

0.00 550.00

6 Address for correspondence with Phone No:

Signature of the candidate with date CERTIFICATE This is to certify that Mr/Ms RENJITH REGI bearing USN 1CR09EC071 is a student of the college and he/she may be permitted to register for the examination .He/She shall satisfy the condition of admission requirements and minimum attendance as prescribed by the university before writing the examination, falling which his/her application may be rejected.

Date Applied :

18-11-2011

Signature of the Principal with college seal

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