UNIVERSITY OF KERALA

Sl. No.

APPLICATION FOR ELIGIBILITY CERTIFICATE

(Read the Instructions carefully) Rates of Fee for Eligibility Certificates 1. 2. 3. Foreign Degrees / Diploma Exams. P. G. and Professional Degrees from outside Kerala, but within India All other Degree / Diplomas / Exams.

Price Rs. 10/-

Rs. 500 350 200

1.

Name of the Candidate (in block letters)

2.

Postal address of the Candidate

3.

Examination passed (for which Eligibility Certificate is required) Name of the University / Board / Institution which awarded the Degree / Diploma / Certificate Register Number and Year of passing Name of Course undergone (Specify whether Regular, Correspondence, Private or Open University Scheme) Course for which admission is sought in the Kerala University or specify the purpose for which Eligibility Certificate is required Details of fee remitted Demand Draft No. / Pay-inslip No. Name of bank, Branch, Date & Amount I hereby declared that the entries made above are correct to the best of my knowledge and belief.

4.

5. 6.

7.

8.

Station : Date : For Office Use only Signature of the Candidate

Verified by

Assistant

Section Officer

Asst. Registrar

Dy. Registrar

1. 2. 3. 4.

Documents to be submitted along with the application for Eligibility Certificate. Attested Photocopies of Mark lists, Pass Certificates, Provisional Certificates or Degree Certificates. Regular School, College Study candidates to attach copy of T. C. or Course Certificate. In the case of Regular or Correspondence or Private candidates attach attested copies of Mark lists and Pass Certificates of Previous examinations viz 10+2 or 10+2+3 (Degree) or 10+2+3+2 (P. G.) In the case of M. B. B. S. / B. D. S. / BAMS / BHMS / B. Pharm. Nursing etc. attach attested Photocopies of Degree Certificate / Provisional Certificate and Completion of Internship Certificate, and Council registration Concerned

kup 62 / 2010-11 30,000