Year of Admission
M.Sc
Karnataka Open University
MANASAGANGOTRI, MYSORE - 570 006
APPLICATION FOR EXAMINATION
ROLL II.D. CARD NO.
Fourth Semester
Affix
Stamp Size
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Note: i ) Please read carefully the instructions given overleaf before filling up the application, as well as instruction in the prospectus.
ii) Strike off whichever is not applicable. ·
Mobile No:
Name of the Examination Centre
1. Name of the Candidate (in block letters):
(as in qualifying examination records)
2. Permanent Postal Address with pin code
(in block letters)
Landline No . . . . Email ID: . . . . . .
Pin Code:
3. Subjects I Papers for which to appear - (compulsonly 1nd1cate Reg No ., Year and Month of pass1ng the prev1ous examinations 1f any) ('P' for assed 'A: for appeanng)
AlP Subjects I Paper Year& AlP Subjects I Paper Year &
(First Semester) Month (Second Semester) Month
Name of the Bank &
Place of Remittance .
Name of the Course M Sc. . . /MBA Class: I!Wlii/IV Sem
Roll No: I I
KSOU-500-EXAMINATION FUND
SBM-54035420128 SBI-31106997538
ORIGINAL
SSM, Manasagangotri, Mysore - 06
SBI, New Sayyaji Rao Road, MysoreOl
Subjects I Paper Year& Subjects I Paper Year & Name and Address of the Student
AlP
(Third Semester) Month
AlP
(Fourth Semester) Month
Amount Rs.
501 , Examination Fee
Penal Fee
Change of Centre Fee :
Total
Amount (in words) Rupees .
Note: Fees once paid·will not be Refunded.
Date: Signatur-e of tbe Remitter-
For tl e ue c1f the Bank
5. do you belong to Cat Cat Cat Cat Cat The Amount of Rupees (in wor-ds) . · .
(mark (v') to which you belong S.C S.T
I IIA liB lilA IIIB
G.M. PH has been r-eceived I
Challan No.
Date & Signatur-e of the Officer-
Bank Seal receiving the money
6. Sex: Male I Female 7. Medium: English
Name of th:nt a State Open tniversity. yso-:e J Name of the Bank & e L H! i ertlt 1 son- ) Name of the Bank & t n t-r l'
Place of Remittance . I Place of Remittance . J Place of Remittance .
Name of the Course M. Sc !MBA Class : l/IIIliiiiV Sem I Name of the Course M. Sc . /MBA Class IllliiiiJIV Sem I Name of the Course M. Sc . .!MBA Class : VII!IIIIIV Sem
Roll No· I Roll No: I Roll o:
KSOU-500-EXAMINATIONFUND I KSOU-500-EXAMINATIONFUND I t___K_SO_U-5_00_-E_X_AM_IN_ AT IO_N_F_UND ___ .J
SBM-54035420128 SBI-31106997538 I SBM-54035420128 SBI-31106997538 1 SBM-54035420128 SBI-31106997538
SSM, Manasagangotri , Mysore - 06 1 SBM, Manasagngotri, Mysore 06 I SBM, Manasagangotri, Mysore - 06
SBI, New Sayyaji Rao Road, Mysore-01 I SBI, New Sayyaj1 Rao Road, Mysore-01 I SBI, New Sayyaji Rao Road, Mysore-01
Name and Addiess of the Student 1 Name and Address of the Student 1 Name and Address of the Student
501: Examination Fee
Penal Fee
Change of Centre Fee :
Total
I I
I I
I
1 501: Examination Fee
Penal Fee
Change of Centre Fee:
Total
lcode No'
1501: Examination Fee :
\\,1 Penal Fee :
Change of Centre Fee :
Amount (in words) Rupees .
1 Total I Amount (in words) Rupees . . *J Amo u nt (in words) Rupees . .
Note: Fees once paid will not be Refunded.
Date : Signature of the Remitter
for the usc of the Bank
The Amount of Rupees (in words)
has been received I
Challan No.
1 Note: Fees once paid will not be Refunded. I Note: Fees once I! aid will not be Refunded.
I Date: Signatur-e of the Remitter- I Date : Signatur-e of the Remitter
II The Amount of Rup'e"e s '( in I The Amount of Rupees (in
words) . . . . . I words) . . . . . .
I has been received 1 I has been received I
Date & Signature of the Officer I Challan No. ) Challan No .
receiving the money I Date & Signature of the Officer I Date &
I Bank Seal receiving the mony I Bank Seal
Bank Seal
To be retained v;ith the recei; ing bak Signature of the Officer
receiving the money
o crera e
9. Details of fees paid:
Year Amount Paid Name of the Bank Challan No. Date
I Semester
II Semester
Ill Semester
IV Semester
I declare that the above information furnished by me is correct to the best of my knowledge.
Date.
Place Signature of the Candidate
Accepted I Rejected FOR OFFICE USE ONLY
Scrutinized by Checked by
IMPORTANT INSTRUCTIONS TO BE FOLLOWED BY THE CANDIDATES
01. Regarding the submission of filled-in application form, read the instructions printed in the exam fee circular and in prospectus.
02. The Examination fee paid Challan in the application along with Admission fee paid photocopy challan should be submitted on or before the due date (without or
with penal fee as prescribed). Otherwise, the application will not be registered for examination.
03. Incomplete applications are liable to be rejected.
04. Challan number etc. should be written in the application form in the space provided above.
05. Examination fees once paid will NOT be re-adjusted I nor refunded under any circumstances.
06. Regarding the rates of examination fees, separate circular is enclosed and also in the prospectus.
07. For all instructions pertaining to examination Dates, Centres, Assignments, nme table, Announcement of Result. Convocation Dates etc. , please see the KSOU website: www.ksoumysore.edu.in
08. KSOU website is updated continuosly. Kindly enter the website often to get complete and recent information regarding the examination.
09. Place in which examination will be held shall be notified 25 days prior to examination in the KSOU website. KSOU shall make all efforts to reach the students
through post. However, KSOU is not responsible for postal delay.
10. The filled -in application should be submitted to The Registrar (Evaluation)., Karnataka State Open University, Manasagangotri, Mysore. 570 006,
within the stipulated date.
11. MOBILE PHONES ARE PROHIBITED IN THE EXAMINATION HALL