Fillable Printable Application for Recaluation/Scrutiny

Application for Recaluation/Scrutiny

DEPARTMENT OF TECHNICAL EDUCATION

APPLICATION FOR REVALUATION/SCRUTINY

(for Three year Diploma in Engg./Technology)

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1. Name of student :

2. Branch of study & Semester/year :

3. Reg. No. & Scheme :

4. Month & Year of Exam :

5. Name of Polytechnic College :

6. Address to which communications are to be

sent (with District and Pin Code) :

7. Whether Scrutiny or Revaluation :

8. Sl. No.& date of Marklist (attach copy :

downloaded from site,if original not issued)

9. Details of Answerscript for which

scrutiny/Revaluation requested

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Marks secured in the examination

Subject Name of subject Written Inetrnal Total

Code

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10.Details of fee remitted (fee to be remitted at the Polytechnic College office)

(1) Amount remitted:

(2) Receipt No. & date

Certified that the details furnished above are correct

Place:

Date: Name & Signature of the Student

Recommended

(Seal) P R I N C I P A L