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 Ph.D
(FOR OFFICE USE ONLY)
PHOTO 1
Paste Your Recent
Passport size
Photograph
(3.5 X 4.5 cm)
(Do not staple /Pin
on photo
1.Received the application in person / by post
2. Date of Receipt ______________
Signature of the Section In-charge
PHOTO 2
Paste Your Recent
Passport size
Photograph
(3.5 X 4.5 cm)
(Do not staple /Pin
on photo
1. Name of the Candidate
(In capital strictly as per the SSC records)
2. Father’s Name
(In capital strictly as per the SSC records)
3. Hall Ticket Number
Name of the Programme
Month & Year of Passing
4. Class obtained (Consolidated Statement of
Marks/ Consolidated Statement of Grades &
Provisional Certificate )
5. Medium
6. Sex Male / Female
7. Full Address
(In Capital Letters)
________________________________________________
________________________________________________
________________________________________________
8. Land Line Phone No.
with STD Code
Mobile No.
FEE DETAILS
NAME OF THE BANK D.D. NO. AMOUNT DATE
Name of the Programme BEFORE CONVOCATION AFTER CONVOCATION AT THE TIME OF CONVOCATION
9. Rs. _____________ /- Rs. ________ /- Rs. __________ /-
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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
10. Name of the Examination passed for which you now apply for Original degree
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 MARKS/GRADE SECURED IN
THEORY Month & Year of Passing
I year /I SEMESTER PAPERS 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
MARKS SECURED IN
PAPERS MARKS 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
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Address for Communication (In Capital Letters) Address for Communication (In Capital Letters)
Name : Name :
Father’s name : Father’s name :
H.no : H.no :
Street / colony Street / colony
Post / village Post / village
Mandal/town Mandal/town
Dist. / state Dist. / state
Pincode Pincode
Phone no. 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. Demand Draft for Rs.______ /-
2. Two Passport size Photographs
3. Attested copy of S.S.C
4. Attested copy Provisional / Degree Certificate of Qualifying Exam or its Equivalent exam.
5. 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.