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PUNJAB TECHNICAL UNIVERSITY, JALANDHAR

DISTANCE EDUCATION PROGRAMME


CHALLENGE EVALUATION FORM
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Exam Session (Mar/Sep) ……………………….. Exam Type (Regular/Re-Appear) …..………….…..……


Applicant Details
Registration/Roll No. Result Notification No.

Course Semester Scheme

Name

Father’s/Guardian’s Name

Phone No. E-mail

Fee Details
Date Bank Name Branch

Demand Draft No. Amount [ Answer Book(s) X Rs.1000/-]

Paper Code & Nominated Faculty Details


Marks Experience In
Paper – ID Faculty Name Qualification
Obtained Years

1.

2.

3.

4.

5.

Applicant’s Signature _____________________________________ Date ___________________

Learning Centre OFFICE USE ONLY Punjab Technical University


LC Code Receiving Date PAPER - ID Revised Marks

LC Name 1.

EDP Soft Copy Received 2.


Centre Head
Sign. & Stamp 3.

Regional Centre 4.
University Accounts
RC Code 5.
Case No. Receipt No.
Receiving Date Signatures:
Dy.
RC Reference No. SO(DEP)
Registrar(DEP)

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