PEOPLE’S UNIVERSITY, BHOPAL (MP)
(All the information should be filled by the Examinee in English only) Examination Centre
(to be filled by the
EXAMINATION FORM (SEMESTER PATTERN) University)
Examinee Status [√]: Regular Repeat/Ex. Month: …………………Year: …………..
1. Program: …………………………………….… 2. Semester: ……………………………………………………
6.
3. Branch: ……………………………………….… 4. Specialization: …………………..………………………..
5. Institute: …………………………………………………………………………………………………………………….. Paste (Do not staple)
recent Photograph
7.Enrollment Number P U - (Size 35mm x 45 mm)
duly attested by the
Dean/Principal/Head of
8. Examinee’s Name (in Capital Letters): …………………………………………..…………………………….
the Institution
9. Father’s/Husband’s Name (in Capital Letters): …………………………………………………………....
10. Mother’s Name (in Capital Letters): …………………………………………………………………………..
11. Date of Birth: ……..……………….. 12. Category: …………….. 13. Gender: ……………14. Nationality: ……………………
15. Correspondence Address: ………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………………………………
District: …………………………………. State: ……………………. Pin Code: ……………………….. Contact No.: ……………………………
16. Details of Qualifying Exam (Attach Attested Photo Copies)
(a) Name of Exam: …………………………………………….. (b) Year of passing: …………………………………………..
(c) Enrollment No: …………………………………………….. (d) Result: …………………………………………………………
(e) College/Institute: …………………………………………. (f) Name of University: ……………………………………
17. I will be appearing for the following Papers:-
Theory Practical
S.No. Paper Code Paper Name S.No. Paper Code Paper Name
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
18. CERTIFICATE BY THE RESPECTIVE CO-ORDINATOR/HOD/GUIDE
This is to certify that………………………………………………………fulfils the eligibility to appear in University examination for
the above mentioned program/papers.
Signature of Coordinator/HOD/Guide with full Name
19. DECLARATION BY THE EXAMINEE
1) I am aware that, I have to fulfill criteria of attendance as prescribed by the University, failing which I shall be held
“Not Eligible” and will not be allowed to appear for examination.
2) I hereby declare that I have gone through the syllabus as prescribed and adopted by the University and relevant
rules off the Head of Passing which are applicable for the examination for which I am appearing and I accept the
same without any challenge (wherever applicable).
3) I shall be responsible if my application form is rejected for any errors, wrong or incomplete entries made by me
in the examination form.
4) I am not defying the criteria of the admission order.
5) I am not admitted to the course after the cut-off date declared by the University for Grant of terms.
Place:
Date: Signature of Examinee in running hand
20. FOR THE USE OF INSTITUTION OFFICE
Attachments
Fee Receipt No. Date Amount (Rs.) Name of Verifying Officer Signature
21. CERTIFICATE BY THE HEAD OF INSTITUTION
I certify :
1. That Shri/Smt./Kum. ……………………………………………………………….. is a bonafide student of this college,
admitted to the ……………………….... Program in the Session 20__-__. He/she is not admitted to the course
after the cut-off date for grant of terms.
2. That his / her attendance and eligibility to appear in University examination is as per University rules /
concerned ordinance/governing council (or body).
3. That the information furnished by the said Examinee is verified from his/her documents and that the
Examinee is Eligible to appear for University Examination.
Place:
Date:
Signature & Seal of the HOI
