FOR UG & PG STUDENTS OF Use this Application Form to request VTU to

NON AUTONOMOUS PROGRAMS send your documents directly to WES by secure electronic transfer

VISVESVARAYA TECHNOLOGICAL UNIVERSITY

“Jnana Sangama”, Belagavi- 590018
APPLICATION BY EMAIL TO REQUEST VTU TO SEND DOCUMENTS DIRECTLY TO WES

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: __ __ – __ __ – __ __ __ __

Name: _____________________________________________ Address: _____________________________________________________________________

Email: _____________________________________________ ____________________________________________________________________________

Mobile: ____________________________________________ _____________________________________________ Signature: ____________________

Name as on Grade/Marks Card: _________________________________________________ USN: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Status of College when enrolled:  CBCS/ Non CBCS Old USN (if applcable): ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Document Fee

Transcript to be sent To WES  ₹ 500 for 1 Transcript

(Note: Attach the WES Academic Records Request Form and  ₹ 300 (1 to 9 DC/PDC + Marks/Grade cards).......... Optional. Attach copy
documents to be attested)  ₹ 600 (10 to 18 documents)................................... Optional. Attach copy
 ₹ 900 (19 to 24 documents)................................... Optional. Attach copy

Medium of Instruction  ₹ 250 ...................................................................... Optional

FEE DETAILS Documents Fee: ₹ _________________

 ₹ 1,500 Processing fee Processing Fee: ₹ 1500-00
Grand Total: ₹ _________________
Fee Payment ID: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Pay fee by SBI Collect on https://vtu.ac.in/en/online-fee-payment. Choose “Category F – Fees to be paid by student Examination”

FOR OFFICE USE ONLY

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

TO BE FILLED IN BY APPLICANT

WES Reference Number: ____ ____ ____ ____ ____ ____ ____
USN:______________________________