Mba Exam Form
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Transcript of Mba Exam Form
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M.Sc/MBA/LLM/MBA LAW/MTM...... / First/Second/Third/Fourth Semester Examination of............20....
Mukthagangotri, Mysore - 570 006
KARNATAKA STATE OPEN UNIVERSITY
6.*Category4.*Address of the Student for Correspondence (Do not write name again)
Single Mark ( ) is for shading the appropriate circle completely. e.g -
Entries must be filled by the candidates himself / herself in**English Capital Letters.
.
Instructions :
**Register Number
2.*Name of the Examination Center
3.*Name of the Candidate (As per SSLC)
1.* Year of Admission
-
7.*M.Sc / MBA/LLM /MBA LAW/ MTM
5.*Sex :
Subjects/Papers for which to appear - Please shade the appropriate circle in front of subject appearing for the Examination.
Residence
Mobile
8. **Telephone Numbers (with STD code)
+91
0
Pin
code
I
II
III
IV
Male
Female
A/P : A - Appearing P - Passed
SC ST CAT-I OBC P.H GM
A/P A/P
A/P
If passed write
year & month
Subjects / Paper
(FIRST SEMESTER)
Subjects / Paper
(SECOND SEMESTER)
If passed write
year & month
A/PIf passed write
year & month
If passed write
year & month
Subjects / Paper
(FOURTH SEMESTER)
Subjects / Paper
(THIRD SEMESTER)
M.Sc in Environment Science & Technology M.Sc in Geography
M.Sc in Mathematics M.Sc in Biochemistry
M.Sc in Biotechnology
M.Sc in Chemistry
M.Sc in Microbiology MBA LLM MTM MBA LAW
M.Sc in Physics M.Sc Information Technology
M.Sc Computer Science M.Sc in Clinical Nutrition & Dietetics
Medium :
Kannada English
-
I declare that the above information furnished by me is correct to the best of my knowledge.
8. Details of the fee paid :
Year
I Semester
II Semester
III Semester
IV Semester
Amount Paid Name of the Bank D.D/ Journal No. Date
Date ...........................
.............................................
Place............ .............. Signature of the Candidate
FOR OFFICE USE ONLYAccepted / Rejected
Scrutinized by Checked by
............................ ............................
IMPORTANT INSTRUCTIONS TO BE FOLLOWED BY THE CANDIDATES
KS
OU
C
OP
Y
KS
OU
-500-E
XA
MIN
AT
ION
FU
ND
Na
me
of
the
Ba
nk &
Pla
ce
of
Re
mitta
nce
....
....
....
....
....
....
....
....
....
....
....
..
Na
me
of t
he
Co
urs
e -
....
....
....
....
....
....
....
....
....
....
..
SB
M :
54035420128 S
BI : 3
1106997538
Ka
rn
ata
ka
Sta
te O
pe
n U
niv
ers
ity,
My
so
re
Ro
ll N
o :
OR
IGIN
AL
SB
M, M
ukth
agangotr
i, M
ysore -
06 C
ode -
40166
SB
I, N
ew
Sayyaji R
ao R
oad, M
ysore -
01 C
ode -
3130
Nam
e a
nd A
ddress o
f th
e S
tudent
A
mo
un
t R
s.
501 : E
xam
ination F
ee :
P
enal F
ee :
C
hange o
f C
entr
e F
ee :
Am
ount ( in w
ords) R
upees ......................................
......................................................................................
Note
: F
ees o
nce p
aid
will not be R
efu
nded.
Date
: S
ignatu
re o
f R
em
itte
r_
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
_
Fo
r t
he
us
e o
f t
he
Ba
nk
Th
e A
mo
un
t o
f R
up
ee
s (
In
wo
rd
s)..
....
....
....
....
.
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
..
ha
s b
ee
n r
ece
ive
d /
Ch
alla
n N
o.
Da
te &
Ba
nk S
ea
l
S
ign
atu
re
of
the
Offic
er
re
ce
ivin
g t
he
mo
ne
y
U
NIV
ER
SIT
Y C
OP
Y
N
ot
to b
e s
ep
ara
ted
fro
m t
he
Fo
rm
1. The filled-in application should be submitted to The Registrar (Evaluation)., Karnataka State Open University,
Muktagangotri, Mysore - 570 006, within the stipulated date.
Mukthagangotri, Mysore - 570 006
KARNATAKA STATE OPEN UNIVERSITY
`
-
ST
UD
EN
T C
OP
Y
SB
M/S
BI
MY
SO
RE
CO
PY
BA
NK
CO
PY
KS
OU
-50
0-E
XA
MIN
AT
ION
FU
ND
KS
OU
-50
0-E
XA
MIN
AT
ION
FU
ND
KS
OU
-50
0-E
XA
MIN
AT
ION
FU
ND
Nam
e o
f th
e B
ank &
Nam
e o
f th
e B
ank &
Nam
e o
f th
e B
ank &
Pla
ce o
f R
em
itta
nce..............................................
Pla
ce o
f R
em
itta
nce..............................................
Pla
ce o
f R
em
itta
nce..............................................
Nam
e o
f th
e C
ou
rse -
............................................................................
Nam
e o
f th
e C
ou
rse -
...................................................................
Nam
e o
f th
e C
ou
rse -
..................................................................
SB
M :
54
03
54
20
12
8
S
BI
: 3
11
06
99
75
38
S
BM
: 5
40
35
42
01
28
SB
I :
311
06
99
75
38
S
BM
: 5
40
35
42
01
28
SB
I :
311
06
99
75
38
Ka
rna
tak
a S
tate
Op
en
Un
ive
rsit
y,
My
so
reK
arn
ata
ka
Sta
te O
pe
n U
niv
ers
ity,
My
so
reK
arn
ata
ka
Sta
te O
pe
n U
niv
ers
ity,
My
so
re
Ro
ll N
o :
Qu
ad
rup
licate
Tri
plicate
Du
plicate
SB
M,
Mu
kth
ag
an
go
tri, M
yso
re -
06
Co
de
- 4
01
66
SB
I, N
ew
Sa
yya
ji R
ao
Ro
ad
, M
yso
re -
01
Co
de
- 3
13
0
Nam
e a
nd A
ddre
ss o
f th
e S
tudent
A
mo
un
t R
s.
501 : E
xam
ination F
ee :
P
enal F
ee :
C
hange o
f C
entr
e F
ee :
Am
ount (
in w
ord
s)
Rupees ......................................
........................................................................................
Note
: F
ees o
nce p
aid
will not be R
efu
nded.
Date
: S
ignatu
re o
f R
em
itte
r
____________________________________________
SB
M,
Mu
kth
ag
an
go
tri, M
yso
re -
06
Co
de
- 4
01
66
SB
I, N
ew
Sa
yya
ji R
ao
Ro
ad
, M
yso
re -
01
Co
de
- 3
13
0
Nam
e a
nd A
ddre
ss o
f th
e S
tudent
A
mo
un
t R
s.
501 : E
xam
ination F
ee :
P
enal F
ee :
C
hange o
f C
entr
e F
ee :
Am
ount (
in w
ord
s)
Rupees ......................................
.....................................................................................
Note
: F
ees o
nce p
aid
will not be R
efu
nded.
Date
: S
ignatu
re o
f R
em
itte
r
____________________________________________
SB
M,
Mu
kth
ag
an
go
tri, M
yso
re -
06
Co
de
- 4
01
66
SB
I, N
ew
Sa
yya
ji R
ao
Ro
ad
, M
yso
re -
01
Co
de
- 3
13
0
Nam
e a
nd A
ddre
ss o
f th
e S
tudent
A
mo
un
t R
s.
501 : E
xam
ination F
ee :
P
enal F
ee :
C
hange o
f C
entr
e F
ee :
Am
ount (
in w
ord
s)
Rupees ......................................
.......................................................................................
Note
: F
ees o
nce p
aid
will not be R
efu
nded.
Date
: S
ignatu
re o
f R
em
itte
r
____________________________________________
Fo
r th
e u
se
of
the
Ba
nk
Fo
r th
e u
se
of
the
Ba
nk
Fo
r th
e u
se
of
the
Ba
nk
Th
e A
mo
un
t o
f R
up
ee
s (
In
wo
rds).
....
....
....
....
..
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
ha
s b
ee
n r
ece
ive
d /
Ch
alla
n N
o.
Da
te &
Ba
nk S
ea
l
S
ign
atu
re o
f th
e O
ffic
er
re
ce
ivin
g t
he
mo
ne
y
Th
e A
mo
un
t o
f R
up
ee
s (
In
wo
rds).
....
....
....
....
..
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
ha
s b
ee
n r
ece
ive
d /
Ch
alla
n N
o.
Da
te &
Ba
nk S
ea
l
S
ign
atu
re o
f th
e O
ffic
er
re
ce
ivin
g t
he
mo
ne
y
Th
e A
mo
un
t o
f R
up
ee
s (
In
wo
rds).
....
....
....
....
..
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
....
.
ha
s b
ee
n r
ece
ive
d /
Ch
alla
n N
o.
Da
te &
Ba
nk S
ea
l
S
ign
atu
re o
f th
e O
ffic
er
re
ce
ivin
g t
he
mo
ne
y
Ro
ll N
o :
Ro
ll N
o :
To b
e r
eta
ined w
ith the r
eceiv
ing b
ank
To b
e s
ent to
Sta
te B
ank o
f M
ysore
, M
ukth
agangotr
i B
ranch,
Mysore
-570006 a
nd S
tate
Bank o
f In
dia
, N
ew
Sayyaji R
oa R
oad,
Mysore
.-1, by the r
eceiv
ing B
ank a
long w
ith M
.T. and S
tate
ment.
Stu
dent
copy t
o b
e r
eta
ined b
y t
he s
tudent.
No s
epara
te r
eceip
t w
ill be issued.
1: M.Sc2: PAGE23: PAGE 3