ANNAMALAI UNIVERSITY

FORM OF APPLICATION FOR REGISTRATION DEGREE/DIPLOMA/CERTIFICATE/GRADE EXAMINATIONS MAY 2014 (FOR STUDENTS OF DISTANCE EDUCATION) ___________________________________________[ALL ENTRIES SHOULD BE IN CAPITAL LETTERS]___________________________________

I. COURSE

Affix recent passport size photo attested by a gazetted officer

II. COURSE CODE

III. ENROLMENT NUMBER

1.EXAMINATION CENTRE CODE:

CENTRE NAME:

2. NAME: 3. SUBJECT CODES OF PAPERS,FOR WHICH APPEARING NOW: I II III IV V VI VII VIII

I-SEM/YEAR

II-SEM/YEAR

III-SEM/YEAR

IV-SEMESTER

V-SEMESTER

VI-SEMESTER

4. EXAMINATION FEES PAID BANK DETAILS: (ENCLOSE ORGINAL D.D.) (A) DD DETAILS: NAME OF BANK : BRANCH CODE : D.D. DATE : ______/______/20___ DD NO: AMOUNT:

(B) CASH CHALLAN (ENCLOSE ORGINAL RECEIPT): PAID AT CASH COUNTER / IB: DATE : (C) ONLINE PAYMENT: NAME OF BANK: DATE : ______/______/20___ TRANSACTION NO: AMOUNT: ______/______/20___ CHALLAN NO: AMOUNT:

5. I HAVE REMITTED THE TUTION FEES UP-TO-DATE. 6. I HAVE ATTENDED THE COMPULSORY PERSONAL CONTACT PROGRAMME.

DATE :

SIGNATURE OF THE CANDIDATE

NOTE: PLEASE RETAIN A COPY OF THE APPLICATION AND THE DD/CHALLAN.