BHARATHIAR UNIVERSITY : COIMBATORE 46.

APPLICATION FORM TO APPEAR FOR THE UG/PG/MBA/MCA DEGREE/ALL DIPLOMA

ARREAR EXAMINATION
[FOR THE STUDENTS OF DISTANCE EDUCATION]

DECEMBER 2016

1. Month & year of Examination

DECEMBER 2016

2. a) Examination Centre Code :

3. Name of the Candidate [In capital letters) :

4. Date of Birth :

5. Enrolment Number :

6. Examination Register No. (Allotted in the previous appearance):

7. Month and year of last examination appeared:

8. Address for communication with Cell No.:

9. Degree & Branch :

10. Subjects to which the candidate takes up the examination appearing in this
appearance:
Title of subjects (Theory and / or Practical]

Subject code

[PTO]

.. 2 ..

Details of Payment & Fee:

1. D.D. No._______________________________
2. Date __________________________________
3. Bank __________________________________
4. Rs._____________________________________
DECLARATION
It is, hereby, declared that the particulars furnished above are true to the best of
my knowledge. I have read the instructions and understood that my candidature will
be cancelled if any of the information furnished is found false.

Station :
Date

Signature of the Candidate