ROLL / 1.0. CARD NO.
KARNATAKA STATE OPEN UNIVERSITY
MUKTHAGANGOTRI, MYSORE - 570 006
APPLICATION FOR EXAMINATION
LLM- First/ Second I Third I Fourth Semester of Year ..................................
Affix
Stamp Size
Photo here
Note: i) Please read carefully the instructions given overleaf before filling up the application, as well as instruction in the prospectus.
ii) Strike off whichever is not applicable.
Mobile No: ...... ... .......... .. ... ....... ............. .... ... .
Name of the Examination Centre
1. Name of the Candidate (in block letters):
(as in qualifying examination records)
2. Permanent Postal Address with pin code
(in block letters)
Landline No: ... ... ....... ...... . Email !D: ... ....... ....... .... .. ... ...... ... ..... .. ......... .
Pin Code
3. SubJects I Papers forwh1ch to appear- (compulsonly 1nd1cate Reg No., Year and Month of passmg the prev1ous exam1nat1ons, 1f any) ('P' for assed, 'f\ for appeanng)
AlP
Subjects I Paper Year&
AlP
Subjects I Paper
(First Semester) Month (Second Semester)
AlP
Subjects I Paper Year& Subjects I Paper
(Third Semester) Month (Fourth Semester)
Year&
Month
Karnataka State Open University, Mysore
Name of the Bank &
Place of Remittance
Name of the Course LLM Class VWUVIV Sem
Roll No
KSOU-500-EXAMINATIONFUND
SBM-54035420128 SBI-31106997538
ORIGINAL A SBM, Mukthagangotri, Mysore - 06
SBI, New Sayyaj i Rao Road, Mysore-01
Name and Address of the Student c
. G Amouut Rs.
501: Examination Fe:
Penal Fee
Change:. :
Date: Signature of the Remitter
5. do you belong to
S.C S.T
Cat Cat Cat Cat Cat
G.M. PH For the use of the Bank
(mark( . ) to which you belong I I lA liB The Amount of Rupees (in words)
6. Sex: Male I Female 7. Medium: English
lilA I liB
has been received I
Challan No .
Date &
Bank Seal
Signature of the Officer
receiving the money
UNIVERSITY COPY
Not to be seperated from the Form
--K-arn-ata-ka -Stat-e O-pen- U-nive-rsit-y, M-ys-ore ---- ---Kar-nat-aka- State O-pen- U-nive-rsit-y, M-ys-ore ---\:1 ---K-arna-tak-a S-tate- Op-en U- m·v-ers-1ty,- M.ys.o)rei i.--
Name of the Bank & I Name of the Bank & arne of the Bank &
Place of Remittance I Place of Remittance ... .... I Place of Remittance
Name of the Course LLM Class l!II/IIIIIV Sem I Name of the Course LLM Class Vll/Ill/IV Sem I Name of the Course LLM Class VIIIIIVIV Sem
Roll No· I Roll No I Roll No L-----------------'
KSOU-500-EXAMINATIONFUND I KSOU-500-EXAMINATIONFUND ...j I KSOU-500-EXAMINATIONFUND
SBM-54035420128 SBI-31106997538 I SBM-54035420128 SBI-31104S9m8l SBM-5403542012. 8 . SBI-31106997538
Duplicate 1 Triplicate " I Quadruplicate
SBM, Mukthagangotri, Mysore · 06 SBM, Mukthagangotri, Mysore. 06 /' '-l SBM, Mukth aggotn, Mysore · 06
SBI, New Sayyaji Rao Road, Mysore-01 I SB I, New Sayyaj i Rao Road, Mysore-0 1 \..) I SB I, New SayyaJl Rao Road, Mysore-0 1 s..
Name and Address of the Student c :Name and Address of the Student :Name and Address of the Student G C
G Amount Rs. Q Amount Rs. . . ·
501: Exammabon Fee ISO!: Examination Fee 1501: Exammatwn :
Penal Fee : Penal Fee . Penal Fee :
Change of"- Fee : I Change of tr,t. ee: I Change C e Fee :
Amount (in wordsX1ees ........ ... .. ... ....................... I Amount (in w ues. ...... .......... .... .... ... IAmo:mt (is) 1ees ....... ............ .... ..... ... ....... .
Note: Fees once paid will not be Refunded. :Note: F': aid will not be Refunded. :Note:. Fees--ice paid will not be Refunded.
Date: Signatu" of the Remitter I Dat'& Y Signatu" of the Remittee I Date. Signatu" of the Remittee
For the use of the Bank : For the use of the Bank I For the use of the Bank
:: .::urnetc:tvuees (in words)............................ I ::d)···t····: .. (i········· : ::d).t .. ···:. (in
Challan No. I has been received 1 I has been received I
Date & Signature of the Officer I Challan No. IChallan No.
Bank Seal receiving the money 1 Date & S•gnature of the Officer 1 Date & Signature o( the Officer
To be retained with the receiving bank I Bank Seal receiVIng the money I Bank Seal receiving the money
Receiving Bank should send this copy to the Finance Student copy to be reta.ned by the student. No seperatc
Officer, KSOU, Ma nasagangotri, Mysore-06 receipt will be illued
7. Details of fees paid:
Year Amou nt Paid Name of the Bank Challan No. Date
I Semester
II Semester
Ill Semester
IV Semester
I declare that the above information furnished by me is correct to the best of my knowledge.
Date ..
Place. Signature of the Candidate
Accepted I Rjected FOR OFFICE USE ONLY
Scrutinized by Checked by
IMPORTANT INSTRUCTIONS TO BE FOLLOWED BY THE CANDIDATES
01. Regarding the submission offilled-in application form, read the instructions printed in the exam fee circular and in prospectus.
02. The Examination fee paid Challan in the application along with Admission fee paid photocopy challan should be submitted on or before the due date (without or
with penal fee as prescribed). Otherwise, the application will not be registered for examination.
03. Incomplete applications are liable to be rejected.
04. Challan number etc. should be written in the application form in the space provided above.
05. Examination fees once paid will NOT be re-adjusted I nor refunded under any circumstances.
06 Regarding the rates of examination fees, separate circular is enclosed and also in the prospectus.
07 For all instructions pertaining to examination Dates, Centres, Assignments, Time table, Announcement of Result. Convocation Dates etc., please see the KSOU
webs ite: www.ksoumysore.edu.in
08. KSOU website is updated continuosly. Kindly enter the website often to get complete and recent information regarding the examination.
09. Place in which examination will be held shall be notified 25 days prior to examination in the KSOU website. KSOU shall make all efforts to reach the students
through post. However, KSOU is not responsible for postal delay.
10. The filled-in application should be submitted to The Registrar (Evaluation)., Karnataka State Open University, Mukthagangotri, Mysore- 570 006,
within the stipulated date.
11. MOBILE PHONES ARE PROHIBITED IN THE EXAMINATION HALL.