UNIVERSITY OF KERALA G. E.

P
APPLICATION FORM (FOR GENERAL & EXAMINATION PURPOSES)

Details of Fee remittance (Add Rs.10/- as service charge if payment is made through For office use only
Demand Draft and Rs. 20/- if the application form is downloaded fron website)
Pay-in-slip/DD No ..........................dt........................Amount Rs.......................

(...................................................................................................................)
remitted at University Cash counter I Friends Janasevakendram/
Bank..................................................................................................... ...........

1. Name of Applicant (In block letters) : ......................................................................................................

2. Date of Birth : ...................................................... Male I Female .............................

3. Address with Phone No. (In block letters) : ......................................................................................................

......................................................................................................

4. PIN (Permanent Identity Number) : ......................................................................................................

5. RANK CERTIFICATE I OFFICIAL TRANSCRIPT I TRANSCRIPT OF MARKS I ATTESTATION OF MARK LIST / ATTESTATION OF
SYLLABUS I ATTESTATION OF DEGREE CERTIFICATE / DETAILED MARK LIST / CONFIDENTIAL MARK LIST / ADDITIONAL
MARK LIST I CANCELLATION OF EXAMINATION I CANCELLATION OF PRIVATE REGISTRATION / DUPLICATE DEGREE CERTIFICATEI
DUPLICATE HALL TICKET I DUPLICATE PRIVATE REGISTRATION MEMO I DUPLICATE REVALUATION MEMO I CERTIFICATE.
ON MEDIUM OF INSTRUCTION, DURATION OF COURSE, DETAILS OF COURSE I PERCENTAGE CERTIFICATE I PHOTOSTAT
COPY OF ANSWER BOOK ETC .....

Purpose (write specifically the requirement

as mentioned in No.5 above.)

Name of the Course

Subject / Branch / Group

Annual Scheme / Semester /

Regular I Pvt. study I IDE

Examination Centre / College

Reg. No. I Candidate Code

Month & Year of Passing

Additional Details

DECLARATION
I do hereby declare that the above particulars are true and correct to the best of my knowledge and belief.

Place :

Date : Signature of the Applicant.

 Fee rates as on 1-10-2016. Confirm current fee rates before remittance of the same
End required Requirement Purpose Fee (Rs.) Remarks
1.4 Confidential marklist Higher Studies First Copy 105
-do- Each Additional Copy 55
Employment Each Copy 210
1.2.3 Additional Marklist All courses Each 55 +search fee (if applicable) **
1.2.3 Detailed Marklist Per part / Semester / Year 55 Per Part+Search fee (if applicable)**
1.3.12 Rank Certificate (First Rank fee exempted) 100
1.3.8.12 Official Transcript 265
1.2.3 Pre-Degree Marklist 840 Year (94 Admission Onward)
1.3.12 Attestation of Marklist / Pre-Degree pass certificate 1050 Per Copy
1.3.12 Attestation of Degree / Diploma / Certificate 1050 Per Copy
Attestation of Syllabus 1050 Per Copy
1.3.14.12 Exam.transcript (Proforma / Questionnaire) 1050 Per Copy
1.3.1.6.17 Duplicate Hall ticket 55 (P. G. Course 75/-)
1.3.6.11 Cancellation of Examination (to be applied within 14 days of the last day of exam. attended 55 Per each written Paper
1.3 Cancellation of Pre-Degree Exam. (Filled up application to be endorsed by Principal of the College) 1050
1.3.9.11.18 Cancellation of Exam. and Private Regn. 1050 Only if registered / appeared for exam.
1.3.9.11.18 Course cancellation for joining another University 525
1.3.15 Duplicate Private Registration Memo 265
1.3.9.10/13 Cancellation of Private registration/unavailed portion without registering for exam. 525
1.3 B.Tech. detailed Marklist I B.Tech. Percentage Certificate 525
1.3.5 Special Certificate 265
1.2.3 Pre-Degree Addl. Marklist 840
1.3.5.7 Pre-Degree Pass Certificate (1996-2006) 525
1.3.5.7 ,, (1957-1979) 1575
1.3.5.7 ,, (1980-1995) 1050
1.3.5.7 Duplicate Degree Certificate I Diploma Certificate (If original has lost irrecoverably) 1050 +search fee if applicable*
1.3.5.7 Triplicate Degree Certificate Rs. 1325 +search fee
1.3.20 Duplicate Degree I Diploma (Original Certificate is torn/mutilated or defaced
but name and Register No. is intact 1050 +search fee if applicable*
1.3 Duplicate Re-valuation Memo 265
* Search fee - upto 1 year Nil, 1 year to 5 years Rs. 100/- a nd after 5 years Rs. 400
** Search fee - upto 1 year Nil, 1 year to 5 years Rs. 50/- upto 10 years Rs. 100/- after 10 years Rs. 200
List of Enclosures
1. Original Cash Receipt / DD for the fee remitted. DD must be drawn in favour of The Finance Officer, University of Kerala, Payable at Thiruvananthapuram.
Name of the applicant and purpose should be written on the reverse side of the DD. Postal orders I Money Orders will not be accepted.
2. Self Addressed sufficiently stamped envelope to send articles by ordinary post.
3. Self Addressed sufficiently stamped envelope to send the documents by Registered I Speed post.
4. Sufficiently stamped (Registered Post) envelope with the address of the institution where the Confidential Marklist is to be sent. Separate envelope for each
institution. Reference, if any, must be superscribed.
5. An affidavit by the applicant on a stamp paper of Rs. 100/- duly attested by a Notary Public / First Class Judical Magistrate stating among other facts, that
the original certificate already issued, the circumstances under which it has been lost and that it has been irrecoverably lost. If it is recovered in future, the
duplicate being issued now shall be surrendered back to the University of Kerala.
6. Recommendation of the Principal / Chief Superintendent of the Examination Centre for cancellation of Examination. (written papers including practicals)
7. Course Certificate from the Principal of the college last studied (for Regular college study candidates / dentification certificate from a Gazetted Officer
(for Private Study candidates)
8. Attested copies of documents (S. S. L. C / X / XII certificate / Transfer Certificate) to prove date of birth.
9. Original Transfer Certificate and Original qualifying Certificates/Marklists.
10. Affidavit of the candidate on stamp paper worth Rs. 100/- stating that the original private Registration memo issued, has been irrecoverably lost and that he
she has not been registered for the exam, attested by Notary Public / First Class Judicial Magistrate.
11. Original hall ticket (attested copy for partial cancellation) 16. Original qualifying certificates
12. Photocopy of Marklist and Certificates 17. Hall ticket form duly filled in duplicate
13. Original Private Registration Memo 18. Original Marklist / Certificate issued
14. Sufficient number (+One copy) of proforma/questionnaire 19. Photocopy of the marklists and certificates
15. Private Registration form dully filled in 20. Remaining portion of tom, mutilated or defaced
original certificate but name and Reg. No. is intact.
APPLY TO
I. For Certificate I Services relating to Academic matters.
The Registrar, University of Kerala, Thiruvananthapuram for Attestation of documents, Special Certificates
II. For other services relating to Examinations.
The Deputy Registrar, Exams III, Private Registration I Matriculation I Migration Pre Degree & B.Com. Degree Exams. (Annual Exams.)
The Deputy Registrar, Exams I B.A. / B.Sc. B.Com. Degree exams. (Annual Scheme)
The Deputy Registrar, Exams IV M.A. / M.Sc. / M. Com. / MSW I M. Phil. B.Ed. / M.Ed. / P & IDE Exams.
The Deputy Registrar, Exams VI All Prof. courses including B. Tech & M.Tech. / MBA& B.A. / B.Sc. / B.Com. (Restructured/VocationaI/Semester
courses)
Office address: University of Kerala, Palayam, Thiruvananthapuram - 695034 Website www.keralauniversity.ac.inEnquiry 0471- 2305994/2386228.
kup 836/2019-’20 50 ,000