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

NON AUTONOMOUS PROGRAMS send your documents directly to CES/NCEES/IQAS or Universities

VISVESVARAYA TECHNOLOGICAL UNIVERSITY

“Jnana Sangama”, Belagavi- 590018
APPLICATION BY EMAIL TO REQUEST VTU TO SEND DOCUMENTS DIRECTLY TO NCEES/CES/IQAS/University

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:  Non-autonomous/ Autonomous;  CBCS/ Non CBCS Old USN (if applcable): ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Document Fee

Transcript to be sent To NCEES/CES/IQAS/ University  ₹ 500 for 1 Transcript

or other similar institutions  ₹ 300 (1 to 9 DC/PDC + Marks/Grade cards)....................... Attach copy
(Note: NCEES/CES/IQAS/University applicants must attach the  ₹ 600 (10 to 18 documents)................................................ Attach copy
Academic Records Request Form and documents to be attested)  ₹ 900 (19 to 24 documents)................................................ Attach copy

Medium of Instruction  ₹ 250

FEE DETAILS Documents Fee: ₹ _________________

 ₹ 1,500 Postage fee (For addresses outside India) Processing Fee: ₹ 1500-00
OR Grand Total: ₹ ______________
 ₹ 1,500 Processing fee (To send by secure electronic transfer to WES) 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:

 Send by email to this email address __________________________________________________________________________________

 Send by post/courier (Give postal address below)

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

Reference Number: __________________________________ USN:_______________________________

Name
Address

PIN/ZIP :