Form No:- _________

ITM (SLS) Baroda University, Vadodara.

Application form for Reassessment of End Semester Examination
Name of Candidate: - _____________________________________ Seat No:- ___________________
Name of School: - ________________________________________ Enrolment NO:- ___________________
Name of Programme: - _______________________ Semester:- ________ Mobile No.:__________________
Email ID:- __________________________________________________________________________________
Sr. No Course Code Course Name Current Grade Reassessment

Date: _______________ Candidate Sign:

Received Rs. ____________ ( ________________________) from ___________________________________ on

Date __________.

Stamp & Sign of Account Section

• Per Course Reassessment Charges is Rs.350
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Office Copy
Application form for Reassessment of End Semester Examination
Seat No: - __________________
Name of Candidate: - ____________________________________ Enrolment No:- __________________
Name of School: - ______________________________________ Semester:- ________________________
Name of Programme: - __________________________________ Payment Mode(UPI/NEFT/Card):_________
Transaction ID:_________________________ Total Fees Paid :- __________________

Transaction Date: _______________ Stamp & Sign of Account Section

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Candidate Copy
Application form for Reassessment of End Semester Examination

Seat No: - __________________

Name of Candidate: - ____________________________________ Enrolment No:- __________________
Name of School: - ______________________________________ Semester:- ________________________
Name of Programme: - __________________________________ Payment Mode(UPI/NEFT/Card):_________
Transaction ID:_________________________ Total Fees Paid :- __________________

Transaction Date: _______________ Stamp & Sign of Account Section