KARNATAKA STATE OPEN UNIVERSITY
Mukthagangotri, Mysore – 570 006, Karnataka, India
&
Academic Collaborator
SCOPE, Bangalore-24
CHANGE OF EXAM CENTRE FORM FOR SESSION ______YEAR_____EXAMINATION
1. Enrollment No. / Roll No. of the Student 2. Study Centre Code
3. Full Name of the Student (As registered with the University)
4. Father’s Name (As registered with the University)
5. Complete address for Correspondence (Do not repeat name)
Telephone No. with STD Code Pincode
6. Course : Stream : Semester :
7. Name of Examination Centre, where the Student requests to be transferred. (Transferee Exam Centre)
8. Bank draft number with details
Bank Name : Amount in Rs. :
DD Number : DD Date :
10. Certificate by Center Co-ordinator :
Certified that the Enrollment number/Roll number, Name, Examination Particulars have been verified
and found correct as per the record.
Signature & Seal of the Centre Head of the
Study Centre
9. Specimen Signature of the Candidate
Date :
¨
Rs. 1000/- Demand Draft should be made in favour of ‘THE FINANCE OFFICER, KSOU , payable at MYSORE, as change of exam centre fees.
NOTE :