UTTARAKHAND OPEN UNIVERSITY Form- 4
BACK PAPER / IMPROVEMENT EXAMINATION FORM -- 201_-201_
Before filling the form please read the instructions given in the Information Brochure.
Back Paper Exam, submit duly filled Examination Form before the last date
1. Enrolment No.
2. Roll No. (Office use only)
RegistrationNo.
3. Programme Code ………………………………
Please tick the appropriate box only
4. Programme Year
Semester
5. Medium
English Hindi
1. Bank Demand Draft Particulars
Issuing Bank Date /Amount
2. Examination Centre Name
Centre Code
3. Name
9.a) Father’s/Husband’sName
b) Mother’s name
10. Complete Address for Correspondence
Pin Code
11- 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
12-Provide details regarding Back Paper

S.N.
Course
Code
Course Title
Foundation/Elective/Application
Oriented Courses

Medium
1
2
3
4
5.
1. Provide details regarding the result in the last examination appeared in the concerned paper

S.N.
Course Code
Course Title
Year in which candidate
has appeared/Year
Medium
Total/Marks
obtained
1
2
3
4
5
6.

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)