Visvesvaraya Technological University

Belagavi – 590 018, Karnataka State, INDIA

EXAMINATION APPLICATION FORM

Name of the College :

Name of the Candidate :

USN of the Candidate :

Reason for filing : Readmission / Court Case / Technical Problem

application offline Other Reasons if any__________________________________________

Subjects applied :

(Mention Subject Codes

only)

Fee Paid : Semester Application Fee Exam Fee Marks Card Fee

(Please note that, filing of

applications for part of
arrear subjects is not
permitted)

Total Fee Paid

The application filed by me is true and correct to the best of my knowledge

Signature of the Candidate:

Certified that, the candidate has submitted his/her application for the subjects for which he/she is eligible to apply:

Signature of the Principal/ HOD

 Visvesvaraya Technological University
Belagavi – 590 018, Karnataka State, INDIA
Admission Ticket for UG/PG Examination JAN 2017
1. University Seat Number :
2. Name of the Candidate :
Photo
3. Subjects applied

Student Copy
Note: Please verify the eligibility of the candidate before issuing the admission ticket

Signature of the candidate Signature of the Principal with Seal Registrar (Eval.)/ Special Officer

Visvesvaraya Technological University

Belagavi – 590 018, Karnataka State, INDIA
Admission Ticket for UG/PG Examination JAN 2017
1. University Seat Number :
2. Name of the Candidate :
Photo
3. Subjects applied

College Copy
Note: Please verify the eligibility of the candidate before issuing the admission ticket

Signature of the candidate Signature of the Principal with Seal Registrar (Eval.)/ Special Officer

Visvesvaraya Technological University

Belagavi – 590 018, Karnataka State, INDIA
Admission Ticket for UG/PG Examination JAN 2017
1. University Seat Number :
2. Name of the Candidate :
Photo
3. Subjects applied

University Copy
Note: Please verify the eligibility of the candidate before issuing the admission ticket

Signature of the candidate Signature of the Principal with Seal Registrar (Eval.)/ Special Officer