RAJIV GANDHI PROUDYOGIKI VISHWAVIDYALAYA (UNIVERSITY OF TECHNOLOGY OF MADHYA PRADESH) EXAMINATION APPLICATION FORM Aix passport UG/PG/PTDC size photo dul REGULAR OR EX atosted fad Instructions : 1, This Examination form should be filled in by the candidate in his/her own. Principal handwriting, 2. Use Capital Letters in Boxes. ‘3. application is not on prescribed form or incomplete, it wil be rejected. 4, Separate examination form should be filup for each Semester/Exam. 5. Use separate application from for each semester Examination DEC / June Year EXAMINATION CENTRE Sr.No. SEMESTER 3. CENTRE CODE 4, BRANCH NAME 4. BRANCH CODE ce eae a Fr LNO. 6. ENROLMENT NO. 4 STATUS 7 8, NAME OF DEGRI [Reguiar [ex | I (7 thats applicable) ——— Name of Examinee (Name in English, should be as per mark:sheet of qualifying exam.) SURNAME NAME In Hindi Father's Name: (Capital) vesent 4 ess Vention subjects (Theory & Pract.) in which appearing with Code No. ‘Appearing in ~ Semester /Year : All Theory / Practical/ Sessional Theory, Practical SNo.[_ Subject Code Tita of the subject ‘SNo.] Subject Code Title of the subject [1 3 4. 5. 8. 7, mount of fees deposited Contd...2CANDIDATE'S DECLARATION : 4. I ceriy that this application has been filled by me and the information given therein is correct and | shall be personally responsible for the same if proved false later on. 2. Lalsocertily that Lam appearing as regular candidate only in he examination being conducted by Rajiv Gandhi Proudyogiki Vishwavidyalaya, Bhopal (M.P) 3. urther declare that | am neither a regular stuclent of any other Education Institution nor appearing in any other Exami nation as regular candidate 4, understand that ifit is found later on that the information furnished above is false then my result of examination will be cancelled, 5. | assure you that | will complete the requirement attendance and sessional work prescribed for the course of my regi tration. Kindly permit me to appear in the examination to be held in (Sem) | accept to abide by allthe rules and ‘regulations of study and examination as prescribed by the institution and Rajiv Gandhi Proudyogiki vishwavidyalaya, Bhopal 6. Ihave read the relevant ordinance applicable to be and have completed all the requirements as given in it. | have Completed my, studies and have no objection in appearing in examination on the date declared by the university, Place Candidate's Signature Full Name Date (To be Certified by the Principal of the Institution) CERTIFIED THAT: 1. The entries in the application form have been examined and verified properly and found correct. The candidate is eligible to appear in the examination as per relevant ordinance and rules of Rajiv Gandhi Proudyogiki Vishwavidyalaya, Bhopal. The candidate has deposited the requisite “x. ‘The aforesaid candidate is not debarred from appearing at the above examination, (Due to rustication, expulsion, atterid- ance, practicals,iliness etc.) and has completed the academic requirement as per ordinance of the university. 4, Itcdue to any reason the student dovs not complete the academic requirement upto the time of exam his admission card will be requirement to the university and the candidate will be dtained from appearing in the examination. Signature of verifying officer ‘Signature of Head Institution with date with Seal B. The form should be signed by the Head of the Institution. Authorisation to olfice staff or puting signature seal is not allowed,