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GITAM Supplementary Exam Form

The document is an examination application form for the Gandhi Institute of Technology and Management. It requests information such as the candidate's name, registration number, exam details including semester and courses applying for, campus location, and contact information. It also requests fee payment details and signatures for recommendation from the Head of Department and Principal/Director.

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Dibya Jivan Pati
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69 views1 page

GITAM Supplementary Exam Form

The document is an examination application form for the Gandhi Institute of Technology and Management. It requests information such as the candidate's name, registration number, exam details including semester and courses applying for, campus location, and contact information. It also requests fee payment details and signatures for recommendation from the Head of Department and Principal/Director.

Uploaded by

Dibya Jivan Pati
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DIRECTORATE OF EVALUATION

GANDHI INSTIUTE OF TECHNOLOGY AND MANAGEMENT


(GITAM)
(Declared as deemed-to-be-University)
VISAKHAPATNAM-530 045, (A.P)
EXAMINATION APPLICATION FORM

Supplementary Repeat Continuous Evaluation


(For Candidates with Backlogs)

Betterment Exam Special Exam Special Drive Exam

1. Name of the Candidate :


(as in SSC, in capital letters)

2. Registered No. :

3. Examination Appearing for : i) Month: …………………….Year: ………………….……

ii) Program:………………… iii) Branch:………………………………….… iv) Semester/Trimester…………..


4. Courses applying for :
S.No. Course Code Title of the course
1.
2.
3.
4.
5.
6.
7.
8.

5. Campus : Visakhapatnam Hyderabad Bengaluru


6. Contact No: Mobile ________________________Landline with STD_________________________
email Id :

7. Fee particulars: Enclose Original Challan/DD to the application.


In case of DD, write your name & Regd. No. on the reverse.
Amount paid: Rs. Challan/D.D No: Date of Payment:

Name of the Bank: Branch :

Place:
Date : Signature of the Candidate
--------------------------------------------------------------------------------------------------------------------------------
(For Office Use only)
Recommended Not recommended

Signature of Signature of
Head of the Department Principal/Director

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