I.

COURSE :
II. COURSE CODE :
:

1.EXAMINATION CENTRE CODE: CENTRE NAME:
2. NAME:
I-SEM/YEAR
II-SEM/YEAR
III-SEM/YEAR
IV-SEMESTER
V-SEMESTER
VI-SEMESTER
(A) DD DETAILS:
AMOUNT:
(B) CASH CHALLAN (ENCLOSE ORGINAL RECEIPT):
(C) ONLINE PAYMENT:
DATE : SIGNATURE OF THE CANDIDATE
DATE : ______/______/20___ AMOUNT:
NAME OF BANK: TRANSACTION NO:
DATE : ______/______/20___ AMOUNT:
______/______/20___
PAID AT CASH COUNTER / IB: CHALLAN NO:
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]___________________________________
III. ENROLMENT NUMBER
NOTE: PLEASE RETAIN A COPY OF THE APPLICATION AND THE DD/CHALLAN.
5. I HAVE REMITTED THE TUTION FEES UP-TO-DATE.
6. I HAVE ATTENDED THE COMPULSORY PERSONAL CONTACT PROGRAMME.
4. EXAMINATION FEES PAID BANK DETAILS: (ENCLOSE ORGINAL D.D.)
NAME OF BANK : DD NO:
BRANCH CODE :
D.D. DATE :
3. SUBJ ECT CODES OF PAPERS,FOR WHICH APPEARING NOW:
I II III IV V VI VII VIII
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