FOR UG & PG STUDENTS OF Use this Application Form when you want VTU

NON AUTONOMOUS PROGRAMS to receive documents to your own address

VISVESVARAYA TECHNOLOGICAL UNIVERSITY

“Jnana Sangama”, Belagavi- 590018
APPLICATION BY EMAIL FOR TO RECEIVE DOCUMENTS FROM VTU

Common application format for sending application by email as per Notification VTU/BGM/Reg(E)/PS/2019-2020/01 dated 05-05-2020
SUBMIT SEPARATE APPLICATION FORM AND PAYMENT ID FOR EACH DIFFERENT DESTINATION ADDRESS
APPLICANT CONTACT INFORMATION (Fill electronically or write in a legible handwriting, ALL CAPS where possible) Date: __ 8 – 1__ 0__ – __2 __0 __2 __0
0 __
NINGARAJU M
Name: _____________________________________________ Address: NO 72,RAMOHALLI,RAMOHALLI POST
_____________________________________________________________________

ningaraj.m777@gmail.com
Email: _____________________________________________ KENGERI HOBLI,BANGALORE SOUTH TALUK
____________________________________________________________________________
7829957129
Mobile: ____________________________________________ BANGALORE-560074
_____________________________________________ Signature: ____________________
NINGARAJU M
Name as on Grade/Marks Card: _________________________________________________ 1 ___
USN: ___ D ___
B ___
1 ___
6 ___
E ___
E ___
0 ___
23 ___
Status of College when enrolled:  Non-autonomous/ Autonomous;  CBCS/ Non CBCS Old USN (if applcable): ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Document Fee
Official Transcripts Number of Transcripts = ____________  ₹ __________ ₹ 500 + ₹
(₹ 500-00 for first Transcript + ₹ 300-00 for each additional Transcript)

Medium of Instruction  ₹ 250

Provisional Degree Certificate–Only if Degree completed in Jan 2020 or Aug 2020  ₹ 400

Semesterwise Consolidated Marks Card–Non CBCS students only  ₹ ___________ = No. of Semesters ____ ₹ 500 per Semester =

All semester single Consolidated Statement of Marks–Non CBCS students only  ₹ 1000

FEE DETAILS Document Fee: 400

₹ _________________
 Postage fee for addresses outside India ₹ 1,500 Postage Fee: 0
₹ _________________
Fee Payment ID P2010081514576272538985
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Grand Total: 400
₹ _________________
Pay fee by SBI Collect on https://vtu.ac.in/en/online-fee-payment. Choose “Category F – Fees to be paid by student Examination”

PDC APPLICANTS ONLY Undertaking: I have not applied for revaluation of any course/subject of the current exam. Signature: ______________________

Non CBCS and

 Non CBCS First attempt total marks of last four semesters (excluding CIP and CIV)  UG CBCS
CBCS
UG Programs 5th Sem 6th Sem 7th Sem 8th Sem 9th Sem 10th Sem Total CGPA > 5.0 Class
B.E./B.Tech./B.Arch
6.23 SC
PG Programs 1st Sem 2nd Sem 3rd Sem 4th Sem 5th Sem 6th Sem Total  PG CGPA > 5.0 Class
MBA/MCA/M.Tech.
CONSOLIDATED MARKS CARD APPLICANTS ONLY (Non CBCS Students only) BE/B.Tech. Semesters 1 to 7, B.Arch. 1 to 9
Semester 1 2 3 4 5 6 7 8 9
First Attempt Marks

Max. Marks (Out of)

Final Result
CONSOLIDATED STATEMENT OF MARKS APPLICANTS (Non CBCS Students only) BE/B.Tech. Semesters 1 to 8, B.Arch. Semesters 1 to 10
Non CBCS
Semester 1 2 3 4 5 6 7 8 9 10 Class
First Attempt Total Marks

FOR OFFICE USE ONLY

Case Workers: 1) _____________ 2) _____________ 3) _____________ Special Officer: __________________ Registrar (Eval): ____________________

To be filled in by Applicant in BLOCK Letters

POSTAL ADDRESS TO WHICH DOCUMENTS ARE TO BE SENT (This portion will be cut and pasted on envelope. Verify for accuracy)

Name NINGARAJU M 1DB16EE023

USN : _______________________________

NO 72,RAMOHALLI,RAMOHALLI POST, KENGERI HOBLI,BANGALORE SOUTH TALUK

BANGALORE-560074
Address

7829957129
Phone Number : ________________________

PIN/ZIP : 560074