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RE EXAMINATION Form

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28 views

RE EXAMINATION Form

Uploaded by

divyendushukla059
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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IPS ACADEMY

Institute of Engineering and Science, Indore


(A UGC Autonomous Institute,Affiliated to RGPV, Bhopal)
EXAMINATION APPLICATION FORM FOR RE-EXAMINATION
Instructions :
1. This Examination form should be filled in by the candidate in his/her Affix passport
own handwriting. size photo duly
2. Use Capital Letters in Boxes.
3. If application is not on prescribed form or incomplete, it will be rejected. attested by
4. Separate examination form should be filled up for each Semester/Exam. Principal
5. Use separate application form for each semester Examination Dec./June Year
………………………

SEMESTER BRANCH ENROLLMENT NO.

Name of Degree

Surname

Name

Father’s Name (In Capital Letter) ………………………………………………………………………….

Present Address

Appearing in …………………….. Semester/Year : All Theory /All Practical


Theory/Practical
S.No. Subject Code Title of the Subject
1.

2.

3.

4.

5.

6.

7.

Fees Details:
1. Examinations Fees (For Re Exam) : Rs. 500/- (Per subject- Maximum-Rs.2500/-)
CANDIDATES DECLARATION:

1. I certify that this application has been filled by me and the information given therein is correct and I
shall be personally responsible for the same if proved false later on.

2. I understand that if it is found later on that the information furnished above is false then my result of
examination will be cancelled.

3. I have read the relevant ordinance applicable to be and have completed all the requirements as given
in it. I have completed my studies and have no objection in appearing in examination on the date
declared by the institute.

Place : ………………………….. …………………………..


Candidate’s Signature

Date : …………………………… Full Name ………………………………

(To be Certified by the Head of the Department)

CERTIFIED THAT :

1. The entries in the application form have been examined and verified properly and found correct. The
candidate is eligible to appear in the examination as per relevant ordinance.

2. The candidate has deposited the requisite fee.

Signature of verifying officer Signature of Head of Deptt.


with date with seal

Details of Fees Submitted

Payment details of Application fees of Rs. Name of Bank : Union Bank of India
……………….. through NEFT Bank transfer Name of A/c : Institute of Engineering and
Science,IPSAcademy, Indore
A/c No. : 616101010050044
NEFT Transaction Ref. No. ………………………...
IFSC Code : UBIN0561614
Date of Transfer …………………………………….

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