GITAM UNIVERSITY DIRECTORATE OF EVALUATION

REPEAT CONTINUOUS EVALUATION (RCE) APPLICATION FORM For Candidates of 2012-13 Academic Year

Paste recent passport size photograph (to be attested by the Head of the Dept.)

1. Name of the Candidate

(as in SSC in Capital Letters)
Fathers Name in full Mothers Name in full

2. Parents 3. Program
Institute

4. Branch
Campus

5. Institution / Campus Visakhapatnam 6. Period of study 7. Register No. 8. Month and Year of Appearance of Final Semester / Trimester From: To: Hyderabad

9. Postal Address

10. Phone No. 11. e-mail Id

Mobile:

Land Line: with (STD) code:

Particulars of Fee : Rs.6,500/- per course. Payment should be made either through Challan to GITAM University Account No.35017, Union Bank of India, GITAM Campus Branch, Visakhapatnam-530 045 OR through DD in favour of GITAM University, Visakhapatnam-530 045. Original challan/DD should be submitted along with this application. Candidates have to write their Name & Regd. No. on the reverse of the Challan/DD. Challan No. / D.D.No. : Name of the Bank : Date :

Amount : In words :

Place: Date:

Signature of the Candidate For Office Use Only

Recommended for the issue of Hall Ticket subject to the candidate fulfilling all eligibility criteria. Not recommended because..

Signature of Head of the Department

Contd.,

GITAM UNIVERSITY DIRECTORATE OF EVALUATION

REPEAT CONTINUOUS EVALUATION COURSES APPEARING FOR Semester/ Trimester Earlier Continuous Evaluation Marks obtained

S.No.

Course Code

Course Title

Signature of the Candidate

Signature of the HOD with office seal