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WestBengalUniversityofTechnology

Backlog Exam. Form for Even Semester 2012


Last date of submission to respective Institute by the student : 16 April 2012 FormofApplicationforBackLog 2nd 4th 6th 8th SemesterExamination2012

fortheDegreeof NAME

in

Stream

incapitalcase

Reg.No. RollNo. Institute'sName(Code) PermanentAddressofApplicant ContactNo.ofCandidate PaperCode

Of200___200__

Paper Name

IdeclarethatIhavefulfilledthecriteriaforappearingattheBacklogpapersofEvenSemesterExamination2012.
_______________________________________________ FullSignatureofApplicantwithDate

ICertifythat
1 2 thestatementsmadebytheapplicantarecorrect; he/shewasadmittedtotheinstituteasperUniversityregulations;

______________________________________________________________ SignatureofthePrincipal/DirectoroftheInstitute/CollegewithdateandSeal N.B.


1 TheExaminationFeesRs.800/.(Nonrefundable)andRs.400/forXCategoryStudent 2 StudentsarerequiredtosubmittheformtotheirInstitutiononly. 3 Ifanyofthestatementsmentionedaboveisfoundincorrect,theExaminationofthecandidateisliabletobe cancelledbytheUniversity.

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