KRISHNA KANTA HANDIQUE STATE OPEN UNIVERSITY
DEGREE EXAMINATION: BCA (5TH. SEMESTER)
SESSION__________ Form No.Ex-14
NAME OF THE STUDY CENTRE :
1. Enrolment Number : (as in enrolment certificate)
2. Name of the Candidate : (in BLOCK letters as per HSLC/BPP enrolment certificate)
First Name Middle Name Last Name
3. Father’s Name : (in BLOCK letters only)
4. Mother’s Name : (in BLOCK letters only)
5. Address for Communication :
________________________________________________________________________________
________________________________________________________________________________
_____________________________________________________ Pin : ______________________
Contact Telephone. No.___________________
6. Caste (P): General ; SC ; ST (Plain) ; ST (Hills) ; OBC/MOBC
7. Sex : Male ; Female ;
8.Examination Passed: : BPP(With Paper-IV) ; HS (Arts/Commerce/Science)
BCA (1st, 2nd, 3rd, 4th Semester):
(Enclose photocopy of Marksheet of BCA Examination & BPP Examination)
Passport size
photograph
to be
pasted
X
Full signature of
the Candidate
To,
The Controller of Examinations
K.K. Handique State Open University
Housefed Complex, Dispur,
Guwahati-6
Sir,
I, hereby present myself as a candidate for the ensuing Degree Examination 5TH.SEMESTER BCA 20..... of Krishna Kanta Handique State Open University.
If any of the statements made and particulars furnished in the application is found to be not true or if it appears that in the opinion of the University, I have contravened any of the provisions of the rules and regulations of the University relating to the Degree examination, my admission to the Examination will be liable to be cancelled.
The fees shown hereunder are forwarded herewith --
i) Examination Fee : Rs. 600/-
ii) Marksheet Fee : Rs. 50/-
iii) Centre Fee : Rs. 200/-
_________________________
Total Rs. 850/-
Yours obediently
Date : (Full signature of the candidate )

CO-ORDINATOR’S CERTIFICATE
I certify that the candidate named above is a duly enrolled student in Degree programme
(_________Course)of this Study Centre and that --
1. He/she has completed the requirements to appear in Degree Examination.
2. His/her conduct has been good.
3. He/she has filled in the particulars himself/herself and put his/her signature in the application in my presence and I believe the subjoined accounts are true.
4. I know nothing against his/her moral character.
5. He/she has not availed of more than 4 chances of appearing in Examination.
Date : Seal Signature
Name :
Accepted/ Not accepted Co-ordinator
OSD (Examination)