Form Na: ASTU/EX/1/2016 ASSAM SCIENCE AND TECHNOLOGY UNIVERSITY GUWAHATI College/Institution Entry Sl. No. MAMINATION, Examination, 2 Semester, Branch . To. ‘The Controller of Examinations, Assam Science and Technology University, Guwahati (Through the Prineipal/ Director wos Collegeltnstitution) 1 request the permission to appear myself at the ensuing, Examination with following particulars duly filled in. {The £00 OF RS cn esntennininenninnennnenen tpemitted herewith vide A.S.7.U. Cash Memo No. ... ete 1 Course Code [|__| __] _ Name ofthe Subject with Grade R* Subject Code with Grade'R' L] os COUR, ssnun Semester, Course Code : | (Subject ta be mentioned clearly) SCN] NAME OF THE SUBJECT. ‘SUBJECT CODE Subject in which he/she registered to be Examined in... PARTICULARS TO BE FILLED IN BY THE CANDIDATE 1, Category of Student: Regular nn 2. Sex: Male Female 3. Caste General [—] OBC [—] MOBC [_] SC [] Others [7] 4. Medium of Examination 5. AS1U. Regisratn Nos [TTT TTT LT) sein (TTT ICT 6, Examination Roll No, I I 7. Name of the Candidate: i I LI [ (sin Regiraton Cenificus) 8 Fathers Name: LITTTTTTT TTT rrr J 9. Mother's Name: I I I 10. Contact No. (Mobile) i I 11, Name of the Collegian : CTT TTT Tr rrr rrr) (Asin Collegetnttiondegay Burd)12. Nationality I i rea M4 15, Present Address : [ Po L I Dist: T I Site: LT TTT Pin: [ DECLARATION OF THE CANDIDATE Ifany of the statements made as.abave in the application are Found ta be not true, or if t appears as such in the opinion of the University, I have in sny way contravened by the provisions of the University Rules and Regulations relating to the Degree examination, my admission to the examination will be liable for cancelation at any time at the diseretion of the University authority before or after the examination/results pae: D[_[_]™ Y Yours faithfully Place on Full Signature of the Candidate CERTIFICATE | certify thatthe particulars furnished by the above named candidate has satisfied me that he/she pasted the H.S.S.L.C/ HS/P.U. (Two yr.) Examination and fulfilled all the requirements under the regulations to be eligible to appear as Regular it swrnmone COUFSE semester Examination He/She has Completed all the other requirements including evaluation of the grading system upto mid-semester examination and the minimum requirement of attendance of 75%. I centfy that his / her conduct and progress in studies have been satisfactory during the eourse of study in this College / Institution within the framework of A.S.TU. Regulations. Further, itis certified that this College/Institution had been granted affiliation by the Assam Science and Technology University, Guvcahati, Principat/Head of the CollegeTastitution Office seal (This form will not be accepted without Seal & Signature of the Principal/Head of the College/Institution,) Approved by Verified by = Controller of Examinations Deputy Controller of Examinations Assam Science and Technology University, Guwahati (Assam ice and Technology University, Guwahati IMPORTANT INSTRUCTIONS TO THE CANDIDATE i, ‘This form is in two partsi.. Original should be filled up with BILACK coloured dot pen ink: Incomplete application js liable to be rejected. (Special care should be taken for filling the Computer use part) lease leave one box [_— ] blank between two words while filling up the form, Please furnish the copies of Previous Examination Certificates like H.S.$.1. C/A.LS.S,E/Diploma/Previous Semester Marksheets and Registration Certificate duly attested by the Principal/Head of the College/Institution, without ‘which the Admit Card will not be issued, iv. Application is to be filled in BLOCK LETTERS. ¥. A student shail not be allowed to appear from a College/Institute which has not been granted affiliation of the ‘University or unless special arrangement for Centre of Examination is made. vii, The Application Form must be submitted within the date fixed and fees for the purpose,