KRISHNA KANTA HANDIQUI STATE OPEN UNIVERSITY
POST GRADUATE DIPLOMA / DIPLOMA / CERTIFICATE COURSE
1ST SEMESTER/ANNUAL SESSION_________________
2ND SEMESTER SESSION__________________________
Form No.Ex-16
NAME OF THE STUDY CENTRE :
1. Enrolment Number : (as in enrolment certificate)
2. Name of the Candidate : (in BLOCK letters only)
First Name Middle Name Last Name
3. Father’s Name : (in BLOCK letters only)
4. Mother’s Name : (in BLOCK letters only)
5. Complete Address :
________________________________________________________________________________
________________________________________________________________________________
Pin : ______________________Telephone/Mobile No._________________________________
6. Caste (P): General ; SC ; ST ; ST (Hills) ; ST (Plain) ; OBC ; MOBC
7. Sex : Male ; Female ;
8. Papers to be appeared in Examination :
(i) _________________________________ (ii) _________________________________
(iii) _________________________________ (iv) _________________________________
9. Examination Passed: : Degree ; Diploma ; Certificate
(Marksheet of the Last Examination to be attached)
(Name of Papers to be written Clearly)
Passport size
photograph
to be
pasted
X
Full signature of
the Candidate
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 PGD/D/C Examination ________________________ 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 PGD/D/C examination, my admission to the Examination will be liable to be cancelled.
The fees shown hereunder are forwarded herewith --
Programme Examination fee Marksheet fee Centre fee Total
PGDMC, PGDHRM, DJMC 50/- 300/-
DCWE, DTM, PGDTHM 50/- 300/-
DCHN, CCA, CMPR 50/- 300/-
DHM, CMRAE, CMREDA 50/- 300/-
PGDBM, PGDCA 50/- 300/-
Yours obediently
Date : (Full signature of the candidate )

CO-ORDINATOR’S CERTIFICATE
I certify that the candidate named above is a duly enrolled student in PGD/D/C programme
(_________Course)of this Study Centre and that --
1. He/she has completed the requirements to appear in PGD/D/C 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.
Date : Seal Signature
Name :
Co-ordinator
Accepted/ Not accepted
OSD (Examination)