KARNATAKA STATE OPEN UNIVERSITY
Mukthagangotri, Mysore – 570 006, Karnataka, India
Academic Collaborator:_____________________________
To,
The Registrar (Evaluation),
Karnataka State Open University,
Mukthagangotri, Mysore (Karnataka)
APPLICATION FOR CONSOLIDATED MARKS CARD (DIPLOMA / UG / PG)

1. Applicant’s Details & Address:
Name : ____________________________________
Father’s/Husband Name: _____________________________
Mother’s Name : ____________________________________
Address : ____________________________________
___________________________________________________
___________________________________________________
Pincode : ________________ Mob. No.:________________
2. Study Center:
Center Code : KSOU/_________
Name : ___________________________________
Address : ___________________________________
___________________________________________________
___________________________________________________
City : ____________________ State : __________________
Pincode : ________________
3. Tel No.
(With STD Code):
4. Email :
5. Name of the Examination : P.G.____________ U.G.____________
6. Stream :
7. Year of Passing :
8. Registration No. :
9. Request for the issue : Consolidated Marks Card
(Diploma/Degree)
Diploma
10. Academic Details:
11. Reason (Indicate briefly the reason or obtaining above certificate) :
12. Details of fees paid :
13. Stamp & Sign of Coordinator of Study Center:
14. Stamp of Academic Collaborator:11. Reason (Indicate briefly the reason or obtaining above certificate) :

DD/Challan No. DD Date DD Amount(Rs.) Bank Name (DD should be payable at Mysore)
Course Stream Semester Month & year of Passing Semester Total Semester Grade
Specimen Signature of the Canditate
Paste one recent passport size
Photograph

For Office Use
Eligibility verified and found correct YES / NO
Fees Received
Certificates verified
Despatched on
References ________________________________
INSTRUCTIONS
a. Certified true copy of 10th or equivalent in case of Diploma students and 10+2 or equivalent in case of B.Tech students and
Degree pass certificate of M.Tech students. (Duly Notarized)
b. Copy of Final pass certificate obtained from the University.(Duly Notarized)
c. Xerox copy of the Marks Sheet of all semesters. (Duly Notarized)
d. Original School Living Certificate in case of Diploma Student & Original Migration from Old University in case of Degree Student.
Note : Along with all relevant documents & DD the application form should be submitted to the study center only.
DD should be in the Name of "The Finance Officer, Karnataka State Open University", Payable at Mysore.
FEES
1. Provisional Pass Certificate (PPC) 400/- 450/-
2. Migration Certificate (Additional Rs.50/- search fee per year) 400/- 450/-
3. Consolidated Marks Card (Additional Rs. 50/- for delay per year) 300/- 350/-
4. Convocation Fee (in Absentia) Additional Search fee per year Rs. 50/-) 700/- 750/-
5. Genuinety Certificate 400/- 450/-
6. Genuinety Certificate/Verification Certificate for overseas students 2000/-
Following documents must be forwarded along with the application :
S. No. Description Fees
UG Rs. PG Rs.
Date :
15. Declaration By the Applicant :
a. I certify that I have read and understood all the provisions indicated in the prospectus and the Circulars published in the website www.ksoumysore.edu.in from time to time.
b. I certify that after being fully satisfied with this course I had decided to get enroled out of my own free will and desire.
c. I further certify that same had been without any inducement and misrepresentation either from the said University or any other person concerned.
d. I shall abide by this undertaking and shall not hold anybody responsible for the same in any manner after the completion of the course.
e. I hereby certify that all the particulars stated in this application are true to the best of my knowledge & belief. In the event of suppression or distortion of any fact made in my application only I will be held responsible.
f. I understand that FEES once paid will NOT be refunded.
Signature of Registrar (Evaluation)