KARNATAKA STATE OPEN UNIVERSITY
.............Application for the Annual Convocation ..........................
(Strikeout whichever is not applicable)
Date : ................... Place : ................................ / Signature of the Candidate
Note : Candidates are informed to read the INSTRUCTIONS printed overleaf before filling this application.
IN PERSON (Ist Class Post-Graduates, All Rank Holders, Medallists / Cash Prize Winners & Ph.D. Awardees)
(Evgg):
IN ABSENTIA (all others)
z / Degree : μAi / Subject : Male :
Female :
Name of the Candidate in full (in Block letters in Kannada and English) as per Marks Card (First name,
to be followed by initials)
Sri. / Smt.
Postal Address (in Block Letters)
Pin Code
(In Person) (In Absentia)
Receipt No. : ...................................... Rs. :....................... Date : .......................
Please write your challan No. and date
Particulars of fee paid
C£¹Üvg IN ABSENTIA G¹Üvg IN PERSON
Please write below your postal address.
To, Degree / Subject : Roll No. :
Sri / Smt. .................................................................
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..................................Pin Code
Telephone/Mobile No......................................
To, Degree / Subject : Roll No. :
Sri / Smt. .................................................................
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..................................Pin Code
Telephone/Mobile No......................................
To, Degree / Subject : Roll No. :
Sri / Smt. .................................................................
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..................................Pin Code
Telephone/Mobile No......................................
To, Degree / Subject : Roll No. :
Sri / Smt. .................................................................
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..................................Pin Code
Telephone/Mobile No......................................
Affix Self Attested
Photograph
Telephone/Mobile No......................................
(a) Details of Degree Examination passed (Along with
previous year markscards, Photo copy of Final Year
Class Declared Marks Card should be enclosed)
(Consolidated Marks Card should not be enclosed)
Reg. No.
Month Year
(b) Examination Centre
Certified that the above Candidate was student of this University from .................... to ....................... and passed .....................
Examination in the year ............................
Signature of the Supt./Asst. Registrar / Signature of the Officer
IMPORTANT NOTE
1) Medal winners, Cash Prize winners and Rank holders and Ist Class Post Graduate Degree holders of MA, M.Com, M.Sc (IT), M.Ed, MLISc, etc (to be present on the convocation day) and can receive PG degree certificates IN PERSON.
2) Those who have passed in 2012 can also receive PG degree IN ABSENTIA (Through Post After Three Months from the Date of Convocation).
3) Those who have secured Gold/Cash Prize Winner & Rank Holders in BA, B.Com, B.Ed, B.Sc (IT), BLISc, BFA can receive degree certificate IN PERSON.
4) Those who have passed BA, B.Com, B.Ed, B.Sc (IT), BLISc, BFA, Diploma programmes should receive degree certificate IN ABSENTIA only (Through Post After Three Months from the Date of Convocation).
Office Use Only
Registration No. : Date :
ELIGIBILITY LIST
Vol. No.:
D.C. No.:
Despatch No.:
Page No.:
Issued Date :
Date :
Sl.No. :
(c) Caste/Category (Indicate) :
Class obtained

Declaration to be signed by candidates is detailed in
this application. This should be invariably signed by the
applicant.

DECLARATION
I hereby solemnly declare and promise that, if admitted to the Degree of ......................... for which I have been recommended, I shall, in my daily life and conversation, conduct myself, as befits a member of this University ; that I shall, to the utmost of my capacity and opportunity, support the cause of morality and sound learning, and that, as far as in me lies, I shall uphold and advance the social order and the well being of my fellowmen.
I shall faithfully and carefully fulfill the duties of the profession to which I may be admitted by virtue of
Degree, that I shall, on all occassions, maintain its purity and reputation and I shall never deviate from the straight path of their honourable exercise by making my knowledge subservient to unworthy ends.
(In case of Non-professional Degrees the 2nd paragraph be scored off)
Place : .....................
Date : ...................... Signature of the Candidate

INSTRUCTIONS TO THE CANDIDATES
01. While sending the application to the Registrar (Evaluation) please superscribe on the cover as
CONVOCATION.....................................
02. Please enter clearly in BLOCK LETTERS in the place provided, the correct Postal Address to which Degree Certificate and communication, if any, is to be sent.
03. You are required to furnish complete information in the form, and then affix a Passport size colour
photograph, TWO photos may be placed in separate envelope and enclosed with the Application.
04. Self attested Photo copies of Marks Cards of all the years shall be invariably enclosed.
05. Ist Class Post-Graduates, Medallists / Prize winners and Rank holders only can take their Degree Certificate IN PERSON. All other will be given the Degree Certificate only IN ABSENTIA.
06. The candidate shall sign in all the places where he/she is required to sign.
07. After payment of the prescribed fee (KSOU Examination Fund Challan) the completed application
form shall be sent directly to the Registrar (Evaluation), Karnataka State Open University,
Manasagan-gotri, Mysore - 570006.
08. Enquires relating to Non receipt of Convocation Application will not receive attention in the University office.
09. Incomplete Applications are liable to be rejected without assigning any reason whatsoever. REFUND OF AMOUNT IS NOT PERMISSIBLE UNDER ANY CIRCUMSTANCES.
10.Candidates who have applied under Inperson Category, if failed to attend the Convocation shall remit an extra Penal Fee Rs. 100-00 for sending the Degree Certificate by Registered Post.
11. After the Convocation, the Degree Certificate will be sent to the eligible candidates (under In absentia category), only through Registered Post. If the said Degree Certificate is returned to the University undelivered, Candidates shall remit an extra amount of Rs. 100-00 to obtain the Degree Certificate.
12.If the Degree Certificate is to be sent outside India, an additional fee of Rs. 800-00 towards Postal Expenses is to be remitted along with the prescribed fee.

SPECIAL INFORMATION
01. The Information relating to the particulars of the Convocation will be notified in News Papers,
KSOU Web Site (www.ksoumysore.edu.in) and also at all Regional and Study Centres of KSOU.
02. If N.C. L is not removed and class is not declared and also name descrepession if any in corrected in their marks cards, such candidates are not eligible to receive the Degree Certificate until they clear their Lower Examinations (N.C.L).
03. If there is any correction in the Original Marks Cards it may be corrected immediately before submitting the application for the Degree Certificate, otherwise, student will be held responsible.
04. Students who passes in the Supplementary Examination just before the Convocation are eligible
only for Provisional Pass Certificate.
05.If the N.C.L is removed and class is declared in original Marks Cards of ICC & CE students, they are eligible to receive Degree Certificate from Mysore University.
NOTE :
i. Payment may be made through KSOU-500 Examination Fund Challan
ii. Payment by Cheque, Postal Orders or M.T. will not be accepted.
iii. Those residing outside Karnataka shall submit the application by paying the amount through KSOU
Examination Fund Challan in any State Bank of India Branch.
iv. Those who are appearing for IMPROVEMENT OF EXAMINATION are not supposed to apply for Convocation Certifiate.
In person Rs. 650-00
In absentia Rs. 750-00
M. Phil /Ph.D Rs. 1000-00 (In person)
M. Phil /Ph.D Rs. 1200-00 (In absentia)
All Diploma Courses Rs. 500-00
Search Fee per year of delay Rs. 50-00
FEE DETAILS
EAz / From
Registrar(Evaluation)
Examination Branch

Karnataka State Open University
Manasagangotri
Mysore - 570 006.
Karnataka
Book Post
On India Government Service
To, Degree / Subject : Roll No. :
Sri / Smt. .................................................................
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..................................Pin Code
Telephone No......................................