Reg. No: B3ENME7931

KANNUR UNIVERSITY

Combined I&II Semester B.Tech Degree (Supple./Improve.) Examinations,April 2015

APPLICATION FORM

Passport Size

Photo(To be

Attested)

Signature of Identifying Officer with Seal(To be signed on the Photograph)Name and Designation

Signature of the Candidate.................................................(To be signed in the Presence of Identifying Officer)

Name of Candidate :RAHUL A S Date of Birth :1996-05-10

Sex : MALE

Address : ALLAKKOTT HOUSE,ONNAKKUNNU,

:KARIVELLUR , 670521

Phone : 9567712228

Category : OBC

Centre and Place of Examination :SADGURU SWAMY NITHYANANDA INSTITUTE OF TECHNOLOGY

Details of Paper Registerd1 ENME7A107TH BASIC MECHANICAL ENGINEERING(S)2 ENME7A108TH BASIC ELECTRICAL ENGINEERING(S)3 ENME7A109TH BASIC ELECTRONICS AND COMPUTER ENGINEERING(S)Details of fee remittedAmount Chalan No. Date of remittance Name of Treasury540 10 07-02-2015 SBT KANHANGAD

I hereby certify that the entries made above are correct to the best of my knowledgeStation :Date :

Signature of Candidate

This is to certify that ......................................................... belongs to SC/ST/Other Backward/Forward Communityappearing for the examination for the First/Second Chance. His/Her Examination fees Rs.................will be claimed byme from the District Harijan Welfare Officer concerned and the chalan for the same sent to the Controller ofExaminations at an early date.

Office Seal Signature of the Principal

Address to which application is to be sent : Controller of Examinations ,Kannur University , Thavakkara , Civil Station (P.O)-670 002