COCHIN UNIVERSITY OF SCIENCE AND TECHNOLOGY

APPLICATION FOR REVALUATION OF ANSWER BOOKS

(Please see instructions overleaf) 1 Name of the Candidate in Block Letters (As entered in the Mark List)

2. Sex 3. Details of Examination i. Name of the Examination ii. Month and ear of the Examination iii. Branch i!. "e#ister N$m%er of the Candidate !. Centre of Examination !i. Date of &$%lication of res$lt '. Details of &a&ers to %e re!al$ed Sl. No. 1. 2. 3. '. ,. -. .. /. (itle of the &a&er(s) ) S$%*ect Code (as in the Mark List) Marks Sec$red Maxim$m Marks S&ace for +ffice $se

00002

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Details of fees pai ! (see Instruction No.6 ) "s. 1mo$nt of fees &aid "i# fi$%&es' If &e(itte i# Cas) at U#i*e&sit+ Cas) Co%#te&, Cash "ecei&t reference (co& "ecei&t No2 of "ecei&t to %e enclosed) If &e(itte -+ De(a# D&aft, Demand Draft reference (see Instruction No.6 - DD No2 IMPORTANT) If &e(itte -+ C)ala# Dated2 Dated2

No000000000.Dated

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1ddress for comm$nication "i# -lo./ lette&s 0 PINCODE to -e .o(p%lso&il+ i# i.ate ' Contact references2 (i) Landline (ii) Mo%ile No. S(D code2 (iii) Email address No2

Name of the Candidate 2 Si#nat$re 3lace2 Date 2 2

INSTRUCTIONS TO THE CANDIDATES 1. +nl candidates for B.(ech4LL.B4MBBS4B.Sc N$rsin#4B.5.Sc De#ree Examinations are eli#i%le to a&&l for re!al$ation. (here is no &ro!ision for re!al$ation of &ractical examinations. 1&&lication for re!al$ation sho$ld %e in the &rescri%ed form and s$%mitted to the Exam Centre alon# 6ith the &rescri%ed fee "s.2.,47 ((6o h$ndred and Se!ent 7fi!e onl ) &er &a&er 6ithin the time limit &rescri%ed for the same in the res$lt notification. "s.1,47 sho$ld also %e remitted to6ards cost of a&&lication. 1 co& of the marklist or &rint o$t of the marks o%tained from the 6e%site of the 8ni!ersit shall %e enclosed alon# 6ith the a&&lication for re!al$ation 9ncom&lete and late a&&lications 6ill %e re*ected. (he res$lt of re!al$ation 6ill %e &$%lished in the official site of the 8ni!ersit . a) 9f the fee is sent % 6a of Demand Draft (DD):
(i) (he DD sho$ld %e &a1# o#2 (a) State Bank of (ra!ancore (SB() or (%) State

2.

3. '.
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Bank of 9ndia (SB9) or (c) 1n associate %ank of SB9 (ii) I# fa*o%& of! (he "e#istrar: C8S1( (iii) Pa+a-le at! (a) 9f dra6n on SB( ; Cochin 8ni!ersit Cam&$s %ranch (Code2 .<23,) = (%) 9f dra6n on SB9 or an associate %ank ; Ernak$lam "i*' (he DD sho$ld %e enclosed to this a&&lication form
-) "emittance % 6a of chalan is a&&lica%le onl in the case of candidates of

chool of !n"ineerin" and #ochin $niversit% #olle"e of !n"ineerin" &uttanad.