KRISHNA KANTA HANDIQUI STATE OPEN UNIVERSITY
______________________ EXAMINATION: 20................
(_____________YEAR/SEMESTER)

NAME OF THE STUDY CENTRE :
1. Enrolment Number : (as in enrolment certificate)
(Not necessary for the 1st Examination)
2. Name of the Candidate : (in BLOCK letters as per HSLC/BPP
enrolment certificate)
First Name Middle Name Last Name
3. Father’s Name : (in BLOCK letters only)
4. Mother’s Name : (in BLOCK letters only)
5. Address for Communication :
________________________________________________________________________________
_____________________________________________________ Pin : ______________________
Contact Telephone. No.___________________
6. Caste : General ; SC ; ST (Plain) ; ST (Hills) ; OBC/MOBC
7. Sex : Male ; Female ;
8.Paper to be appeared in the Examination
(i)_________________________(ii)_______________________(iii)__________________________
(iv)_____________________________(v)_______________________(vi)______________________
(vii)___________________________(viii)_________________________________
9.Examination Passed: : ______________________________________
(Marksheet of the Last Examination to be attached)
(Name of the papers to be written clearly)

To,
The Controller of Examinations
K.K. Handiqui State Open University
Housefed Complex, Dispur,
Guwahati-6
Sir,
I, hereby present myself as a candidate for the ensuing ________________________
Examination 20...... of Krishna Kanta Handiqui State Open University.
If any of the statements made and particulars furnished in the application is found to be not true or if it appears that in the opinion of the University, I have contravened any of the provisions of the rules and regulations of the University relating to the __________examination, my admission to the Examination will liable to be cancelled.
The fees shown hereunder are forwarded herewith --
Programme Exam Fee Marksheet Fee Centre Fee Total
Yours obediently
Date : (Full signature of the candidate)

CO-ORDINATOR'S CERTIFICATE
I certify that the candidate named above is a duly enrolled learner in _________programme
of this Study Centre and that --
1. He/she has the required eligibility to appear in ____________ Examination.
2. His/her conduct has been good.
3. He/she has filled in the particulars himself/herself and put his/her signature in the application in my presence and I believe the subjoined accounts are true.
4. I know nothing against his/her moral character.
5. He/she has not availed of more than 4 chances of appearing in Examination.
6. He/She got back in paper (s)____________
( photocopy of the marksheet to be attached)
Date : Seal Signature
Name :
Accepted/ Not accepted Co-ordinator
OSD (Examination)