You are on page 1of 6

KRISHNA UNIVERSITY

RAJUPETA, MACHILIPATNAM, KRISHNA DISTRICT 521001 (A.P)

Application Form for obtaining the Degree in Advance and in Absentia for PG (M.Pharm. /MCA /MBA/M.Sc.,/M.A.,/MHRM/M.Ed/M.Com.) , B. Ed. and Ph.D. Programmes (Strike off whichever is not applicable)
Programme PHOTO 1 1.Received the application in person / by post Paste Your Recent Passport size Photograph (3.5 X 4.5 cm) (Do not staple /Pin on photo 2. Date of Receipt ______________ Paste Your Recent Passport size Photograph (3.5 X 4.5 cm) (Do not staple /Pin on photo Ph.D (FOR OFFICE USE ONLY) PHOTO 2

Signature of the Section In-charge

1 2 3

Name of the Candidate (In capital strictly as per the SSC records) Fathers Name (In capital strictly as per the SSC records) Hall Ticket Number Name of the Programme Month & Year of Passing Class obtained (Consolidated Statement of Marks/ Consolidated Statement of Grades & Provisional Certificate ) Medium 6. Sex Male / Female

Full Address (In Capital Letters) Land Line Phone No. with STD Code
NAME OF THE BANK D.D. NO.
BEFORE CONVOCATION Rs. _____________ /-

________________________________________________ ________________________________________________ ________________________________________________ Mobile No. FEE DETAILS


AMOUNT
AFTER CONVOCATION Rs. ________ /-

DATE
AT THE TIME OF CONVOCATION Rs. __________ /-

9
Name of the Programme

----------------------------------------------------- - ------ Cut here ---------------------------------------------------------------ACKNOWLEDGEMENT (to be filled by the candidate)

Received application for ______Degree certificate from Sri / Ms. __________________________ H.T No _________________ , on ________________along with D.D. No . _____________ , for an amount for Rs._________/- drawn on _________________dated ___________ In Person / By Post Signature of the Receiver with Seal and Date

Name of the Examination passed for which you now apply for Original degree
10

M.Pharm / MCA /MBA/M.Sc.,/M.A.,/MHRM/M.Ed/M.Com. and B.Ed.


(Please enclose attested copies of the Marks memos/Grade Cards, Consolidated Statement of Marks/ Consolidated Statement of Grades & Provisional Certificate)
NAME OF THE COURSE I year /I SEMESTER PAPERS MARKS/GRADE SECURED IN THEORY Month & Year of Passing MARKS / GRADE

1 2 3 4 5 6 7 8 9 10 II Year / II SEMESTER PAPERS 1 2 3 4 5 6 7 8 9 10 III Year/ III SEMESTER PAPERS 1 2 3 4 5 6 7 8 9 10

IV Year/ IV SEMESTER PAPERS 1 2 3 4 5 6 7 8 9 10 V Year/ V SEMESTER PAPERS 1 2 3 4 5 6 7 8 9 10 VI SEMESTER PAPERS 1 2 3 4 5 6 7 8 9 10 VII SEMESTER PAPERS 1 2 3 4 5 6 7 8

9 10 VIII SEMESTER PAPERS 1 2 3 4 5 6 7 8 9 10 IX SEMESTER PAPERS 1 2 3 4 5 6 7 8 9 10 X SEMESTER PAPERS 1 2 3 4 5 6 7 8 9 10 GRAND TOTAL MARKS / CGPA With Total Credits :

11

If you apply for your Ph.D. degree, mention the Name of the previous Examination Passed (Please enclose attested copies of the Marks memos & Provisional Certificate)
NAME OF THE COURSE PAPERS MARKS MARKS SECURED IN Month & Year of Passing

1 2 3 4 5 6 7 8 9 10 GRAND TOTAL :

DECLARATION BY THE CANDIDATE

1. I Solemnly promise and declare that if admitted to the _________ Degree will in my daily life and conversation conduct myself so as to become a member of the University. 2. I sincerely promise and declare that to the best of my ability and opportunity I will use my powers for the furtherance of true learning. 3. I solemnly promise that I will faithfully and diligently fulfill the duties of the profession to which I eventually belong and that will on all occasions maintain its purity and reputation. 4. I request that my _____________ Degree Certificate may be issued to me in advance and in absentia.
Date: Station: Signature of the Candidate -----------------------------------------------------------------Cut Here -------------------------------------------------------------------------Address for Communication (In Capital Letters) Name : Fathers name : H.no : Street / colony Post / village Mandal/town Dist. / state Pincode Phone no. Address for Communication (In Capital Letters) Name : Fathers name : H.no : Street / colony Post / village Mandal/town Dist. / state Pincode Phone no.

INSTRUCTIONS 1. Candidate should Affix Two (2) Passport size (3.5 X 4.5 cm) photographs on the application in the places provided for the photographs (Do not staple or pin on the photos, small size photos will be rejected). 2. Students desirous of taking their degree in absentia have to fill in this form and submit to the Controller of Examinations, Krishna University duly filled in along with prescribed fee paid through a Demand Draft, on any Nationalized Bank, drawn in favour of The Registrar, Krishna University. 3. The candidate is instructed to be very careful about the entries to be made in all the columns. 4. All entries should be made in CAPITAL letters and in candidates own handwriting and he/she will be held personally responsible for any incorrect entry that he/ she makes. 5. Signature of the candidate is compulsory on application. CHECK LIST 1. 2. 3. 4. 5. Demand Draft for Rs.______ /Two Passport size Photographs Attested copy of S.S.C Attested copy Provisional / Degree Certificate of Qualifying Exam or its Equivalent exam. Attested copy of Consolidated Statement of Marks/ Consolidated Statement of Grades and all semester Marks memos / Grade cards for which now you have applied for Degree Certificate. 6. Xerox copy of identity card issued by college/university.

NOTE: Your Application will be rejected, If, you do not enclose any one of the above checklist.

You might also like