PIONEER INSTITUTE OF PROFESSIONAL STUDIES, INDORE(AN AUTONOMOUS INSTITUTE ESTABLISHED IN 1996 & IS AFFILIATED TO DAVV, INDORE)

EXAMINATION FORMForm No. :........................

Year of Examination Roll No. (To be allotted by Exam. Section)

Class : MBA (FT) /MBA (PT) /BBA /BCA /B.Com ....................................................................... Semester .......................

Specialization : 1) ......................................................................... 2) .........................................................................

Note : All details should be written in clear handwriting in CAPITAL letters English only. Read all footnotes before filling.

Details written here will be printed on Marksheet. Incomplete Examination Form will be rejected.

Enrollment No.

Gender

M/F

AttemptNo.

Reg./Ex./ATKT

R/E/A

CategoryGen/SC/ST/OBC

Student's Name and Surname

Shri/Smt./Kum .............................................................................................................................

Fathers/ Husbands Name : Shri .......................................................................................................................................

Mothers Name : Smt. ......................................................................................................................................................

Students

Address :

Subjects/Papers to appear in the Examination Code No Subjects/Papers to appear in the Examination Code No

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

P.T.O.

Verified by Principal

Seal & Sign.

Affix your latestpassport size colour

photo

(within the box)

FORM COST RS.100/-

Telephone No. : .......................................... Mobile No. : ...............................................................................

Name of Exam Pass/ATKT Roll No. Year Marks obtained/ Name of the Total marks University/Board

passed from

Details of Previous Exams (Attested copies of Marksheets to be enclosed)

For ATKT students

Marks to be carried forward of subjects already cleared :

Table below should be filled in by those candidates only who are repeaters in one or more subjects

S.

No.

Subject Description Code Theory Practical Internal Total Out of

Marks

Obtd

Out

of

Marks

Obtd

Out

of

Marks

Obtd

Out

of

1

2

3

4

5

6

7

8

9

ONLY FOR FINAL SEMESTER STUDENTS

(Please attach photocopies of all previous Semester Examination Marksheets cleared)

Year / Semester Roll No. Marks Obtained Out of Marks-Year of Passing

I Semester

II Semester

III Semester

IV Semester

V Semester

VI Semester

Total

Total

Total

I request permission to present myself at the ____________________ Examination to be held in __________________ conducted by

the Institute. I declare that the facts & information provided in the examination form above are complete & correct to the best of my

knowledge & belief. I am also aware that my admission shall become invalid if I make wrong declaration and undertake to abide by the

decision of the Institute in such a situation, even in cases when such wrong declaration is discovered subsequently.

DECLARATION

Full Signature of Student

(For Office Use only)

- 2 -

Date : .................................

Signature of Receiving Clerk : .......................................... Date : ..................................

Ist Y

ear

II

nd Y

ear

III

rd Y

ear

Fee Details : Receipt No. ........................................ Date ................................... Amount in Rs. ...........................