KARNATAKA STATE OPEN UNIVERSITY

Mukthagangotri, Mysore - 570 006

EXAMINATION APPLICATION FOR FIRST/SECOND/THIRD YEAR B.A PROGRAMME

Month...............Year.........

Instructions : Entries must be filled by the candidates in** Capital Letters.

.
Single
Mark ( ) is for shading the appropriate circle completely. e.g -

Regulation : R1

R2

1.**Register Number

2.* Year of
Admission

II

III

3.*Name of the Examination Center

4.*Name of the Candidate (As per SSLC)

6.*Category

5.*Address of the Student for Correspondence (Do not write name again)

ST

SC

CAT-I

OBC

7.*Sex :

P.H

GM.

8.*B.A :

Male

Female

II

III

9. **Telephone Numbers (with STD code)

Residence
Mobile

0
+91

NOTE :- Subjects/Papers for which to appear - Please shade the appropriate circle in front of subject appearing for the Examination.

Second Year Examination

First Year Examination

If passed write
year & month

LANGUAGE (SELECT ANY TWO)

1. Kannada

2. English

3. Hindi

5. Sanskrit

6. Telugu

7. Tamil

4. Urdu

If passed write
year & month

LANGUAGE (SELECT ANY TWO)

1. Kannada

2. English

3. Hindi

5. Sanskrit

6. Telugu

7. Tamil

Compulsory Optional Subject : ICHR & ES

Compulsory Optional Subject : ICHR & ES

OPTIONAL SUBJECT (SELECT ANY THREE)

OPTIONAL SUBJECT (SELECT ANY THREE)

4. Urdu

1. Kannada

7. Education

1. Kannada

7. Education

2. English

8. Psychology

2. English

8. Psychology

3. History

9. Hindi

3. History

9. Hindi

4. Sociology

10. Urdu

4. Sociology

10. Urdu

5. Economics

11. Anthropology

5. Economics

11. Anthropology

6. a. Pol-Science

12.Geography

6. a. Pol-Science

12.Geography

b. Pub-Adminisration

b. Pub-Administration

(Select Any One)

(Select Any One)

BPP

Applies For Regulation I (R1) students only

Third Year Examination

If passed write
year & month

OPTIONAL SUBJECT (SELECT ANY THREE)

KANNADA (III)

URDU (III)

ECONOMICS (III)

EDUCATION (III)

GEOGRAPHY (III)

KANNADA (IV)

URDU (IV)

ECONOMICS (IV)

EDUCATION (IV)

GEOGRAPHY (IV)

KANNADA (V)

URDU (V)

ECONOMICS (V)

EDUCATION (V)

GEOGRAPHY (V)

ENGLISH (III)

HISTORY (III)

POL-SCIENCE (III)

PSYCHOLOGY (III)

ENGLISH (IV)

HISTORY (IV)

POL-SCIENCE (IV)

PSYCHOLOGY (IV)

ENGLISH (V)

HISTORY (V)

POL-SCIENCE (V)

PSYCHOLOGY (V)

HINDI (III)

SOCIOLOGY (III)

PUB-ADMN (III)

ANTHROPOLOGY(III)

HINDI (IV)

SOCIOLOGY (IV)

PUB-ADMN (IV)

ANTHROPOLOGY(IV)

HINDI (V)

SOCIOLOGY (V)

PUB-ADMN (V)

ANTHROPOLOGY(V)

11. Medium : Kannada / English

10. Sex: Male / Female

12. Year in which
BPP Exam Appeared / Not
Candidate completed
the Programme

II Year

I Year

III Year

13. Details of the fee paid :

Year

Amount Paid

Name of the Bank

Challan No.

Date

I Year
II Year
III Year

I declare that the above information furnished by me is correct to the best of my knowledge.

.............................................
Signature of the Candidate

Date ...........................

Place............ ..............

FOR OFFICE USE ONLY

Accepted / Rejected

............................

............................

Scrutinized by

Checked by
IMPORTANT INSTRUCTIONS TO BE FOLLOWED BY THE CANDIDATE

1. Please read carefully the instructions given in the application, as well as in the
prospectus and fee circular before filling the application.
2. IT IS COMPULSORY FOR THE CANDIDATE TO ENCLOSE ATTESTED
PHOTO COPIES OF THE PREVIOUS YEAR MARKS CARDS WITHOUT
FAIL.
3. The application along with the Examination (original) and Admission
(xerox copy) Fee paid challans should be submitted on or before the due date
(with or without penal fee as prescribed in the fee circular). Otherwise, the
application will be rejected.
4. Freshers, who have enrolled for I, II or III year B.A. course in the current
academic year should compulsorily pay the examination fee in full and must
appear for all the subjects/papers in their respective class.
5. Incomplete applications are liable to be rejected.

Karnataka State Open University, Mysore

Name of the Bank &
Place of Remittance..............................................
Name of the Course B.A : I / II / III
Roll No :

KSOU-500-EXAMINATION FUND
SBM : 54035420128 SBI : 31106997538

ORIGINAL
SBM, Mukthagangotri, Mysore - 06 Code -40166
SBI, New Sayyaji Rao Road, Mysore - 01 - Code-3130
Name and Address of the Student

KS

C
U
O

Y
P
O
Amount Rs.

6. The prescribed examination fee should be remitted in the bank through the
challan printed in the examination form.

501 : Examination Fee

Penal Fee
Change of Centre Fee

:
:
:

7. Examination Fees once paid will not be re-adjusted / refunded under any
circumstances.

Amount ( in words) Rupees ......................................

...................................................................................
Note : Fees once paid will not be Refunded.

8. Regarding the rates of Examination Fees, separate Circular is enclosed.

9. For all instructions pertaining to the examination Dates, Centres,
Assignments, Time Table, Announcement of Result, Convocation Dates etc.,
please see the KSOU Website:www.ksoumysore.edu.in.
10.The filled - in application should be submitted to the REGISTRAR
(EVALUATION), Karnataka State Open University, Mukthagangotri,
Mysore - 570 006.
11. MOBILE PHONES ARE STRICTLY PROHIBITED IN THE EXAMINATION HALL.

Date :

Signature of Remitter

____________________________________________

For the use of the Bank

The Amount of Rupees ( In words).............................
.....................................................................................
has been received /
Challan No.
Date &
Bank Seal
Signature of the Officer
receiving the money
UNIVERSITY COPY
Not to be separated from the Form

PY

Roll No :

/S
M
B

has been received /

Challan No.
Date &
Bank Seal
Signature of the Officer
receiving the money

has been received /

Challan No.
Date &
Bank Seal
Signature of the Officer
receiving the money

For the use of the Bank

For the use of the Bank

The Amount of Rupees ( In words).....................

............................................................................

Date :
Signature of Remitter
____________________________________________

Date :
Signature of Remitter
____________________________________________

The Amount of Rupees ( In words).....................

............................................................................

...................................................................................
Note : Fees once paid will not be Refunded.

...................................................................................
Note : Fees once paid will not be Refunded.

Amount Rs.

P
CO

Amount ( in words) Rupees ......................................

501 : Examination Fee

:
Penal Fee
:
Change of Centre Fee :

M
BI

R
YS O

Name and Address of the Student

SBM, Mukthagangotri, Mysore - 06

SBI, New Sayyaji Rao Road, Mysore - 01

Code -40166
Code-3130

SBI : 31106997538

Triplicate

SBM : 54035420128

SBI : 31106997538

ST

Amount Rs.

Y
P
O

Code -40166
Code-3130

has been received /

Challan No.
Date &
Bank Seal
Signature of the Officer
receiving the money

The Amount of Rupees ( In words).....................

............................................................................

For the use of the Bank

Date :
Signature of Remitter
____________________________________________

...................................................................................
Note : Fees once paid will not be Refunded.

Amount ( in words) Rupees ......................................

501 : Examination Fee

:
Penal Fee
:
Change of Centre Fee :

E
D
U

C
T
N

Name and Address of the Student

SBM, Mukthagangotri, Mysore - 06

SBI, New Sayyaji Rao Road, Mysore - 01

Quadruplicate

SBM : 54035420128

KSOU-500-EXAMINATION FUND

Name of the Course B.A : I / II / III

Roll No :

Name of the Course B.A : I / II / III

KSOU-500-EXAMINATION FUND

Name of the Bank &

Place of Remittance..............................................

Karnataka State Open University, Mysore

Name of the Bank &

Place of Remittance..............................................

Karnataka State Open University, Mysore

Amount ( in words) Rupees ......................................

Penal Fee
:
Change of Centre Fee :

O
C
Amount Rs.
NK
A
B
501 : Examination Fee
:

Name and Address of the Student

SBM, Mukthagangotri, Mysore - 06

SBI, New Sayyaji Rao Road, Mysore - 01

Code -40166
Code-3130

SBI : 31106997538

Duplicate

SBM : 54035420128

KSOU-500-EXAMINATION FUND

Roll No :

Name of the Course B.A : I / II / III

Name of the Bank &

Place of Remittance..............................................

Karnataka State Open University, Mysore