Application Form For Correction in Marksheet

1. Applicant’s Details: 2. Study Center:
4. Details of Original Marksheets Forwarded:
3. Correction Required in Marksheets:
5. Details of fees paid : (Rs. 100/- per Marksheet)
DD/Challan No. DD Date DD Amount(Rs.) Bank Name (DD should be payable at Mysore)
Sr.No. Course Stream
Correction Should be in
Semester
Current Marksheets
Marksheets Sr. No. Session
Correction Required
KARNATAKA STATE OPEN UNIVERSITY
Mukthagangotri, Mysore – 570 006, Karnataka, India
www.ksoumysore.edu.in
Total No. of Marksheets :
Signature of the Applicant:____________________
For Office Use
Fees Received: __________________________
Document verified: __________________________
Dispatched on References: __________________________
Signature of Registrar (Evaluation)
Date :
To,
The Registrar (Evaluation),
KSOU,
Mukthagangotri, Mysore (Karnataka)
Academic Collaborator:________________________________________
Sub.: APPLICATION FOR CORRECTION IN MARKSHEET
6. Declaration by the Applicant :
a. I certify that I have read and understood all the provisions indicated in the prospectus
and the Circulars published in the website www.ksoumysore.edu.in from time to time.
b. I certify that after being fully satisfied with this course I had decided to get enroled out
of my own free will and desire.
c. I further certify that same had been without any inducement and misrepresentation
either from the said University or any other person concerned.
d. I shall abide by this undertaking and shall not hold anybody responsible for the same
in any manner after the completion of the course.
e. I hereby certify that all the particulars stated in this application are true to the best of
my knowledge & belief. In the event of suppression or distortion of any fact made in
my application only I will be held responsible.
f. I understand that FEES once paid will NOT be refunded.
7. Seal & Signature of Study
Center Coordinator:
8. Seal & Signature of Academic
Collaborator:
INSTRUCTIONS
1. DD should be in the Name of “The Finance Officer, Karnataka State Open University”, Payable at Mysore.
2. Documents required.
i) Original Marksheet to be corrected.
th ii) For name correction please attach Photo Copy of 10 Marksheet duly attested.
1. Name
2. Internal Marks
3. External Marks
4. Course
5. Stream
6. Semester
7. Other
(Specify)____________________________________
Reg. No. / Enrol. No.: ____________________________________
Name :____________________________________
Father’s Name :____________________________________
Mother’s Name :____________________________________
Address :____________________________________
______________________________________________________
Pincode : ________________ Ph. No.:____________________
Email : ________________________________________________
Center Code : KSOU / ________________________________
Name : ______________________________________
Address : ______________________________________
______________________________________________________
______________________________________________________
City : ____________________ State : _____________________
Pincode : ________________ Ph. No.:_____________________
Email : ________________________________________________