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KARNATAKA STATELAW UNIVERSITY

HUBLI-580 025
APPLICATION FOR ISSUE OF PASSING CERTIFICATE

Name of the Candidate( in Block letters) as per previous

year Marks Card
Male/Female

Registration Number
Month and Year of Passing with Class obtained
(please attach copies of all earlier Marks Card and
Certified copy of sixth/tenth Semester result sheet).

Particulars of fees of fees paid

D.D.Number.
Note:

Amount Rs.120/-

D.D. Date

Please write your permanent postal address correctly in the given below Box and candidates
should note that the same portion will be pasted on the envelope in which Passing Certificate will
be posted. Hence, Candidates are informed to write legibly and completely.

__________Speed Post_________
To,
Sri/Smt.
.
.

Pin Code
Telephone/Mobile No..
Date:
Place:
Signature of the Candidate
Certified that the above Candidate was student of our College from to.. and passed
..

Examination in the year

Signature of the Principal with Seal