VISVESVARAYA TECHNOLOGICAL UNIVERSITY, BELAGAVI

Application for Issue of CONSOLIDATED STATEMENT OF MARKS CARD

(The Candidates, on fulfillment of requirements, can directly apply to the office of
The Registrar (Evaluation), V.T.U. Belagavi– 590 018 )

1. Name of the Candidate

(As per Marks Cards)

2. University Seat No. (if Any OLD USN:

Payment ID No. : Date: Amount Rs.

3.Details of fee paid
Name of the Bank:
Note: Consolidated Statement of Marks Card (CSM) Fee: Rs 1000/- Enclose Online Receipt of Fees Paid.
• FEES AMOUNT ONCE RECEIVED CANNOT BE REFUNDED. APPLICANT MUST CHECK AND
ENSURE THAT PAYMENT BEING MADE IS CORRECT.
• Enclose Copies of Marks Cards (self attested)

4. Details of Examination Passed

Semester 1 2 3 4 5 6 7 8
FIRST ATTEMPT
(Only Total Marks)
5. Year
Year & month of Degree completion:_________________ Class of the Degree:_____________________
Degree:_____________________

6.PERM
6.PERMAN
PERMANENT
ANENT ADDRESS : ____________________________________________________________________

_________________________________________________________________________________________

Pin:_________________Contact No (Res)_____________________ MOBILE: _____________________

Date: ____________ Signature of the Candidate

Token No :
For Office USE Only CSM No: ___________________
Post B/H

Case worker :- ____________ Special Officer :- ________________ Registrar (Eval.)_____________

POSTAL ADDRESS TO WHICH CSM TO BE SENT ( IN CAPITAL LETTERS )

Name : USN:

ADDRESS :

Pin Code: Contact No. (Resi)…………………………… Mob:………………..…………