GONDWANA UNIVERSITY, GADCHIROLI

EXAMINATION FORM APPLICATION STUDENT COPY Summer 2019

Exam Form No:635701
NAME OF COLLEGE: BALLARPUR INSTITUTE OF TECHNOLOGY BAMNI,BALLARPUR CHANDRAPUR [College Code 393]
NAME OF EXAMINATION THIRD SEMESTER B.E. C IVIL ENGINEERING
ENROLLMENT NO. /PRN 2016033700260563 CONTROL NO. S1903930200500635701
NAME OF CANDIDATE CHOUDHARI MAYUR MADHU
MOTHER'S NAME MAMTA
STUDENT TYPE Repeater
GENDER MALE
CATEGORY
MEDIUM English
ECONOMICA LLY
BA CKWORD NA PHYSICA L HA NDICA P NO
IF PHYSICALLY HANDICAPPED, IS BLIND NA
CORRESPONDANCE ADDRESS
CITY/TOWN PIN
DATE OF BIRTH E-MAIL MOBILE
SUBJECT THEORY PRACTICALS,SESSIONALS AS PER CURRENT SYLLABUS IN TO APPEAR AT THE EXAM
S.NO Paper Code SUBJECT NAME AM-AT
1 FLUID MEC HANIC S-I THEORY (UA)
2 STRENGTH OF MATERIAL THEORY (UA)
0
0
0
0
0
0
0
0
0
0
0
0
FEES DETAILS
Degree Fee 0 Dissertation Fee 0 Exmination 971 Exmination 0
Fee Fee(Ext)
Late Fee 0 Practical Fee 0 Processing 0 Project Fee 0
Fee(Ext)
Provisional Viva-
Degree Fee 0 SuperLate Fee 0 Examination 0 Total 971
Fee
Receipt No 56695 Receipt Date 08-Apr-2019
PARTICULARS OF EXAMINATION TO BE FILLED IN BY THE REPEATER (I.E. FAILURE STUDENT INCLUDING STUDENT
REMAINED ABSENT AT THE EXAMINATION)
SESSION 2018 NAME OF EXAM
YEAR
ROLL NO 2217773 ENROLLMENT NO 2016033700260563 SEMESTER WINTER
DECLARATION
I request permission to present myself for the ensuing examination. I have remitted the prescribed fee for the same. I hereby
declare that all statement made in this application are true, complete and correct to the best of my knowledge and belief. I have
gone through the syllabus and the list of books prescribed for the examination for which I am appearing. I shall not request for
any special concession such as change in time or day fixed for university Examination etc. on religious or any other ground. I
understand that in the event of any information being found false or incorrect, my candidature is liable to be cancelled or
rejected.
PLACE DATE
_
_
_ CANDIDATE SIGNATURE
DECLARATION BY PRINCIPAL/HOD/CHAIRPERSON
This form is carefully scrutinized by the College staff and by me. The information printed in the form is correct to the best
of my knowledge. I also undertake the responsibility of fulfilment/rectification of the information. He/she is regular student
of this College and has completed the required attendance and practical course/term work (if any) according to university
rules.
PLACE: DATE:
_
_
_
_ SEAL & SIGNATURE OF PRINCIPAL
FORM SAVED ON:03-09-2019 14:57:38 LOGIN ID: SUPPORT NOS:1800 0000 0000
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