UNIVERSITY OF KERALA Appl icat ion for Registrat ion Universi ty Examinat ions - Gulf Centres A. General Details 1. Name of the Course 2. Specialization 3. Centre of Examination (Use abbreviations if needed) B. Personal Details 4. Student ID No. (if already allotted) 5. Name of the Candidate (Leave space between words) 6. Date of Birth (DD - MM - YY) 7. Sex (F/M) 8. Nationality 9. Religion 10. Community 11. Permanent Address (Leave space between Words) 12. Communication Address (Leave space between Words) Pin 13. E-mail Address: ....................... 14. Phone No. with Country Code (if any) - 15. Mobile No. C. Qualifying Examination Details (If appearing for 1st Sem/Year for the first time) 16. Name of Examination 17. Specialization 18. University / Board 19. Register No. / Candidate Code 20. Scheme Code 21. Sem./Year 22. Exam. Month 23. Exam Year 24. Class/Division D. Details of Examination 25. Sem/Yr 26. Admn. Year 27. Details of Subjects now appearing for Subject Name / Paper Name 28. No. of Papers Pin ( P l e ase re ad i n s t r uc t i ons i n p a ge 4 ,5 & 6 be fo re f i l l i n g u p t he f o r m ) E. Fee Details 29. Date of Payment 30. Payment Mode (DD - MM - YY format) ('C' for cash 'D' for Draft) 31. Whether Group Payment 32. Serial No. (Y or N) (if group payment) 33. Amount Rs. 34. Draft No. & Date 35. Name of the Bank F. Matriculation Details (If appearing for 1st sem. / Year for the first time) 36. Institution last attended 37. University affiliation of Institution (If applicable) 39. Date of Matriculation Order (If applicable) I here by declare that the entries made in this application form are true to the best of my knowledge and that they have been made in my own hand writing. Place : Date : Signature of the Candidate I hereby certify that the information furnished by the candidate in this application has been verified by me and that I have found them to agree with the records available in this office. The candidate has a valid matriculation in this University with matriculation No. dated........................................... Date : Office Seal Signature of the Director IDE Signature of the Identifying officer (both on the Photograph and inside the box) Place: Date: Signature of the Candidate Name and Designation of the Identifying officer with seal Affix a passport size Photograph (Photo needed only for the first appearance in the first semester / year of Course) 38. Valid Matriculation Order No. (of Kerala University)
