Un_iversityof Jaml11u

}\ppli~atlon Form for CorroGtlon/Chonge in Nftme/P"re.n1;~9Q/$Yb Caste

Naill.e Father's Nalno ,..

Registration Number """',"""~"""""""

Particulars of the examination on the basis the candinate was registered with the University:. .

J) Name of the examination passsed by the candidate .......... .. .. ........ ....

2) Roll No (3) Year (4) Session , ,..."
5) Nan1e of the University/Board ,., "., ,., , ,.,.
Others examinations passed/appeared.
S. No. Name of the examination Year Session Roll No. Name of
0 niversity/Board
a) ,
b)
c)
d)
Whetherapplyingfor correction or change in particulars.., ............ ......
Particulars recorded in the University Correction/Change- requested by the Candidate
Name ;....... Name ,.........
Parentage ...... Parentage ..............

Fees Rs .remitted vide University receipt No , .Dated............

Cashier

Signature of the applicant

Fulladdress..............................
"""""'" """""""""""

Forwarded to the Coi1trol1er of the Examinations for making correction/change in the

particular as req:1ested by the candidate. The candidate has signed in my presence.

Principal/Head of the Department

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The applicants must satisfy the following requirements for change in name/parentage.
1) To furnish with the application' an affidavit sworn in before a Magistrate 1st. class by
the father or Guardian of the candidate in the following form :-
"I solmnaly declare that. . . . . , , . , , ,°.. , , ,is my son/daughter and it is he/she who has
applied for correction in °his/her name of the 'parentage."

2) To advertise the proposed changed in at least one newspaper and to attach the
relevant cutting from tIle newspaper along with the application form.
3) To deposit in cash the advertisement charges, if any, of the notification to be published
in the Government Gazette.

4) The candidate applying for change in name/parentage to the university on basis of

change in name;. authorised by the High School/Higher Secondary Board should be
req~ireq to' pay the fees prescribed' under s;tatus but be not required to fulfil other
statutory requirements in respect of advertisements in newspaper Of Government
Gazette.