UTTARAKHAND OPEN UNIVERSITY Form-3
EXAMINATION FORM—201_ - 201_
Before filling the form please read the instructions given in the Information Brochure
Submit duly filled Examination Form before the last date.
1. Enrolment No.
2. Roll No. (Office use only)

Registration No.
3. Programme Code ---------------------------------------- .................................................................................................
(Please tick the appropriate box only)
4.
Programme Year
Semester
5. Medium
English Hindi
6. Bank Demand Draft Particulars
Issuing bank challan No Date / Amount
7. Examination Centre’s Name
Centre Code
8. Name
a) Father’s/Husband’s Name
b) Mother’s Name
9. Complete Address for Correspondence
Pin Code
10. Permanent Address
Pin Code
Mobile Telephone No. with STD Code
1st 2nd 3rd
Paste your Latest
Passport Size
(4×5cm)
Photograph Duly
Attested by
Yourself
11.Please indicate correct course code and complete course title in which you intend to give the examination.
S.N.
Course Code
Foundation Course’s Title
Medium
1
2
3
S.N.
Course Code
Course Title
Medium
1
2
3
4
5
6.
7.
8.
S.N.
Course Code
Elective Course’s Title
Medium
1
2
3
4.
5.
6.
7.
8.
12. I hereby declare that submission of assignments prescribed for these courses is a pre-requisite for appearing in the examination. I also state that my registration for the above courses is valid and no time barred. If my statement is found untrue, I will have no claim for appearing in the examination. I undertake that I shall abide by the rules and regulations of the University. I have signed undertaking on this ……………………… day ………………. of 201…………………………………

(Signature of the Student)