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Pà Áðlpà Àpáðgà Váawæpà Àjãpáë Àäaqà

This document appears to be an application form for semester diploma examinations from the Department of Technical Education in Karnataka. It requests information such as the candidate's name, institution, course details, religion, category, native district, and whether they are a regular student or external candidate. The candidate must certify that the information provided is correct and include copies of marks cards and income certificates if needed. The form is then signed by the candidate and principal for verification and payment of fees.

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Advaith Shetty
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1K views2 pages

Pà Áðlpà Àpáðgà Váawæpà Àjãpáë Àäaqà

This document appears to be an application form for semester diploma examinations from the Department of Technical Education in Karnataka. It requests information such as the candidate's name, institution, course details, religion, category, native district, and whether they are a regular student or external candidate. The candidate must certify that the information provided is correct and include copies of marks cards and income certificates if needed. The form is then signed by the candidate and principal for verification and payment of fees.

Uploaded by

Advaith Shetty
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PÀ£ÁðlPÀ ¸ÀPÁðgÀ

vÁAwæPÀ ¥ÀjÃPÁë ªÀÄAqÀ½


GOVERNMENT OF KARNATAKA
DEPARTMENT OF TECHNICAL EDUCATION
BOARD OF TECHNICAL EXAMINATIONS
Application for* ……………….20….Semester Diploma Examinations (* Write month of Exam)
(To be filled in by the Candidate)

01. Institution Code

02 Name of the Institution………………………………………………...............................

03. Course Name & Code: ……………………………………………………………………

04. Name of the candidate (in block


Letters)

05. Father’s Name

06. Mother’s Name


(The above Names should be
as per S.S.L.C. Marks Card and Space
should be left for initials & surname)

07. Sex (Write B for Boy G for Girl)

08. Religion

Religion Hindu Muslim Christian Buddist Jain Sikh Parsis Anglo Others
Indian
Code 1 2 3 4 5 6 7 8 9

09. Category

Category SC ST Cat-I IIA IIB IIIA IIIB GEN


Code 1 2 3 4 5 6 7 8

10. Write PH for Physically Handicapped otherwise write “NO”

11. Write R for Rural and U for Urban

12. Native District (Refer District Code)

13. District in which Candidate is studying at present (Refer District Code)


14. SSLC or Equivalent examination passed
(if Karnataka SSLC write 1
if equivalent exam in Karnataka write 2
if non-Karnataka SSLC equivalent write 3)
15. Diploma Register No.

16. a) Are you regular student in current semester? YES NO

b) If “YES” Give full exam details of current Semester.


SEM Subject Codes (To be filled by Student) Fees (Office Use)
01 02 03 04 05 06 07 08

c) Part Exam: Give details of failed subjects in previous semesters, if any.


Semester Subject Codes (To be filled by Student) Fees (Office Use)**
01 02 03 04 05 06 07
I
II
III
IV
V
VI
**Fees to be calculated semester wise. If more than two subjects in any semester collect full fees.

17. For I T I Lateral Entry Scheme student:


Bridge Subject Codes (To be filled by
Sem Student) Fees (Office Use)
01 02
III
IV

18. External: If the candidate registered as an External Candidate write “Y” otherwise “N”.

Certified that the information furnished by me is correct to the best of my knowledge and
attested copies of marks cards & Income certificate (if any) are enclosed herewith.

Mob.No.

Date: Signature of Candidate.


Place:
(For Office Use Only)
Certified that the information furnished by the candidate is verified by me and found correct.

Date: Signature of the Head of Section


Place:
(a) Total Fees Paid : Rs
(b) Receipt No.& Date :
(c) Serial No. in the Consolidated List
(d) Scrutinised by : Initials of the case worker:
Initials of the Suptd. / Registrar

Date: SIGNATURE OF THE PRINCIPAL.


Place:

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