COST OF APPLICATION Rs.

50/-

Serial No:

PERIYAR UNIVERSITY
PERIYAR PALKALAI NAGAR, SALEM - 636 011. T.N, INDIA

APPLICATION FOR UG / PG DEGREE EXAMINATION

1. Register Number : DEC/MAY 20

2. Study Centre Code :

Passport Size
3. Exam Centre Code : Photo with
Student’s
4. Exam Centre Name : Signature
(Compulsory)
5. Name of the Student :
(in Block letters in English, Leave a box between names)

(Name in Tamil)

6. Sex : Male/ Female

7. Date of Birth :
(Date) (Month) (Year)

8. Nationality :

9. Community : OC BC MBC SC ST

10. Father’s Name :

11.Mother’s Name :

12.Medium of Study : Tamil /English

13.Year of Admission :

14.Name of the Degree :

15.Branch of Study :

16.Permanent Residential Address :

17.Mobile Number :

18.E-mail ID :
 19.Details of Qualification acquired :

Qualification Month & Year of Passing Name of the University/Board Class

20.Subject code for which the Student is appearing :

A). Theory B). Practicals/Projects
1. 8. 1.

2. 9. 2.

3. 10. 3.

4. 11. 4.

5. 12. 5.

6. 13. 6.

7. 14. 7.

21.Fee Details :

Theory Papers Practical/Project Provisional Exam Centre Fee Change Penalty

Cost of Statement and Degree of Exam Postal fee Grand
Total Total Total Total Application of Marks Certificate Centre Charges (if any) Total
No. of Amount No. of Amount Tamilnadu Other State Fee
Papers Papers

22.Particulars of the Demand Draft :

Name of the Bank :
D.D.No. :
Date :

Signature of the Principal / Co-ordinator Signature of the Student with Name

 PERIYAR UNIVERSITY
PERIYAR PALKALAI NAGAR, SALEM-636 011.
TAMILNADU, INDIA.

INSTRUCTIONS TO THE STUDENTS

1. The Application form should be carefully filled in by the Student in his/her

own handwriting.

2. Students should forward their Application through the Study Centre

Co-ordinator.
3. Hall Tickets can be downloaded from the University Website
www.periyaruniversity.ac.in

4. Application with incomplete particulars are liable to be rejected.

5. Students should write their names as previously registered in the University

Admission Records.

6. Accurate Date of Birth should be given.

7. Students should give the correct and complete Permanent Postal Address,
Mobile Number and E-mail ID as it would ensure all communication reaching
them without delay.

8. Students should write their Subject Code legibly.

9. For the first appearance Students should register for all the Subjects.
10. The Application form should be submitted along with the necessary fee in the
form of DD drawn in favour of “The Registrar, Periyar University, Salem -
636 011”, payable at Salem and it should be forwarded to The Controller of
Examinations office.

11. The result of the Students will be withheld if the Student has wrongly
entered his/her Register Number, Subject Code, Date of Birth in the
Application or Answer Book.

12. Register Number once assigned to the Student will continue till he/she
completes the Course. Any discrepancy in the Register Number should be
brought to the notice of the Controller of Examinations through the
Study Centre Co-ordinator immediately.
13. The Examination Schedule, Time Table and the details of Exam Centre can be
downloaded from the University Website www.periyaruniversity.ac.in

14. The passport size photograph should be affixed without fail.

15. There is no provision for improvement examination in PRIDE.