PALAMURU UNIVERSITY
P.U PG ADMISSIONS -2013:: ICR SUMMARY SHEET

Instructions to fill the ICR Summary Sheet Registration No.
a. Do not staple, wrinkle, scribble, wet or fold this form. (For office use only)
b. Use Black ball point pen to fill the form.
c. Leave one box blank between surname and name.
d. Write relevant cod es in the boxes as applicable.
e. Do not make any stray marks on this ICR fo rm.
f. Make sure that the letters/codes written shou ld not touch the
edges of the boxes.
1. Name of the candidate [write in CAPITAL letters without touching edges of the boxes]
2. Father’s/Mother’s Name [write in CAPITAL letters without touching edges of the boxes]
3. Date of Birth
4.Fee paid Rs.
Darken the appropriate circles below fully with BLACK ball point pen
5. Category : SC ST BC-A BC-B BC-C BC-D BC-E Others
6. Name of the qualifying examination: B.A. B.Sc B.Com Others
7. Residential Status (See Annexure-I in Information Brochure) Local Non Local Others (Other than A.P)
8. Sex : Male Female
9. Minority Status : Muslim Christian Linguistic Sikh Zorastrian
10. Special Category
NCC NSS SPORTS CAP PH TEACHER LAB ASSISTANT
11. Address for communication:
(Write in CAPITAL LETTERS with ball point pen only)
Name:
Address:
PIN
Mobile/Phone No.
13. Signature of the candidate
(within the box given above)
D
D
M
M
Y
Y
Y
Y
12. Affix your recent Passport size Photograph (Do not Pin/Staple the Photograph)