UNIVERSITY OF KERALA www.keralauniversity.edu APPLICATION FOR CHANGE OF NAME To The Registrar, University of Kerala Through The Principal Details of remittance of fee Amount Rs.-----------------------------------Name of S.B.T.Branch--------------------Pay-in slip No.-------------------------------Date------------------------------------------ 1. Name of the applicant in full (The name to be changed in BLOCK LETTERS) 2. The name of the college affiliated to this University through which he/she was first admitted for a course study in this University 3. The year in which he/she was first admitted to a course of study in this University 4. The name of the colleges in which he/she is now studying/last studied 5. The course for which the candidate is now studying/last studied 6. Duration of the courses attended From To Name of the University a. P.D.C. b. Graduation c. Post-Graduation d. Others i. ii. iii. 7. Details of Examinations passed from this University Reg.No.Month and year Name of Examination Year of passing/appearance Month Reg.No. a) b) c) d) e) 8. Change in name proposed (BLOCK LETTERS) (Please read the instructions overleaf carefully before filling in this application form) 9. Address to which communications are to be sent 10. Reasons for changing the name 11. Whether a copy of the notification regarding change of name published in the Government Gazette is attached (Specify Details) 12. Signature of the applicant Station: Date: CERTIFICATE BY THE PRINCIPAL Certified that the entries made above have been verified and found correct. The reasons assigned for changing name are satisfactory. The application for change of name is recommended. Station: Office Seal Signature of the Principal Date: Instructions 1. The proposed change in name of the applicant has to be notified in the Kerala Government Gazette (Notification in the Gazettes of other states are not acceptable). 2. A fee of Rs.100/-* has to be remitted through University pay-in-slip or DD drawn from SBT or SBI or any National Bank in favour of Finance Officer, University of Kerala, payable at Thiruvananthapuram. 3. The application should be sent through the Principal of the College affiliated to this University where he/she last studied. Applicants undergoing Private study may submit their applications directly to the University. Those who are attending correspondence course should forward their applications through the Director, Institute of correspondence Course. 4. The printed page of the Gazette containing the change of name notification should be sent along with the application form. *Subject to Change
