KSOU Degree Requisition Form

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KARNATAKA STATE OPEN UNIVERSITY
Application for the Annual Convocation ……………………………………………

(Strikeout whichever is not applicable)
Note:- Candidates are requested to read the INSTRUCTIONS printed overleaf before filling this
application.
(Put a (√) against the column which ever is applicable)
IN PERSON (For Post-

IN ABSENTIA (all others) Graduates, Medalists / Prize
Winners and Rank Holders)
Degree: Subject: Male:
Female:
Name of the Candidate in full (in Block letters)
as per Final Year Marks Card (First name, to Sri. / Smt.
be followed by initials)
_______________________________________________
Permanent Postal Address (in Block Letters) _______________________________________________
_______________________________________________
_________________ Pin Code
Please write your Challan / DD No. and date

Affix Self Particulars of fee paid
Attested IN PERSON IN ABSENTIA
Photograph
DD/ Receipt No. : ………… Rs. : ………………… Date : ………..…………

DD Bank : …………………………
Date : ……………………… Place : ………………………….. Signature of the Candidate
Please write below your communication postal address legibly.
To, Degree / Subject : Roll No. To, Degree / Subject : Roll No.
Sri / Smt. …………………………………….. Sri / Smt. ……………………………………..

……………………………………………….. ………………………………………………..
……………………………………………….. ………………………………………………..
……………………………………………….. ………………………………………………..
…………… Pin Code …………… Pin Code
Degree / Subject : Roll No. Degree / Subject : Roll No.

To, To,
Sri / Smt. …………………………………….. Sri / Smt. ……………………………………..
……………………………………………….. ………………………………………………..
……………………………………………….. ………………………………………………..
……………………………………………….. ………………………………………………..
…………… Pin Code …………… Pin Code
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(a) Details of final Year Examination Final Year Examination Class obtained
Passed (Xeroxed copy of Final
Year Class Declared Marks
Card should be enclosed)
(Consolidated Marks Card Reg. No. Month Year
should not be enclosed)
(b) Whether passed the lower
examination after passing the No / Yes (if yes, give details)
final year Examination? Please
give details.
(c) Date of Removal of N.C.L. /
Declaration of Class : (N.C.L. Examination :
Not cleared Lower semester / Centre
year Examination)
Office Use Only

Registration No. : Date :
ELIGIBILITY LIST
Vol. No. : Page No. : Sl. No. :
D.C. No. : Issued Date :
Dispatch No. : Date :
Certified that the above Candidate was student of this University from ………………. to ……………… and
passed ……………………… Examination in the year …………………….
Signature of the Officer

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Declaration to be signed by candidate is detailed in this application. This should be invariably

signed by the applicant.
DECLARATION
I hereby solemnly declare and promise that, if admitted to the Degree of
…………………. for which I have been recommended, I shall, in my daily life and
conversation, conduct myself, as befits a member of this University; that I shall, to the
utmost of my capacity and opportunity, support the cause of morality and sound
learning, and that, as far as in me lies, I shall uphold and advance the social order and
the well being of my fellowmen.
I shall faithfully and carefully fulfill the duties of the profession to which I may be
admitted by virtue of Degree, that I shall, on all occassions, maintain its purity and
reputation and I shall never deviate from the straight path of their honourable exercise
by making my knowledge subservient to unworthy ends.
(In case on Non-professional Degrees the 2nd paragraph be scored off)
Place : ………………...
Date : ………………… Signature of the Candidate
INSTRUCTIONS TO THE CANDIDATES

01. While sending the application to the Registrar (Evaluation), please super scribe on
the cover / envelope as CONVOCATION ………………………
02. Please enter clearly in BLOCK LETTERS in the place provided, the correct Postal
Address to which Degree Certificate and communication, if any, is to be sent.
03. You are required to furnish complete information in the form, and then affix self
attested a stamp size colour photograph, TWO photos (without self attested) may
be placed in separate envelope and enclosed with the Application.
04. Self attested Xerox copies of Marks Cards of all the years/ semesters shall be
invariable enclosed.
05. Post-Graduates, Medalists / Prize winners and Rank holders only can take their
Degree Certificate IN PERSON. All other will be given the Degree Certificate
only IN ABSENTIA.
06. The candidate shall sign in all the places where he/she is required to sign.
07. After payment of the prescribed fee (KSOU -09 Examination Fund Challan or
demand draft) the completed application form shall be sent directly to the
Registrar (Evaluation), Karnataka State Open University, Manasagan-gotri,
Mysore – 570006.
08. Enquires relating to Non receipt of Convocation Application will not receive
attention in the University office. If a self – addressed inland letter is enclosed to
the Application, or if submitted in person, acknowledgment will be given.
09. Incomplete Applications are liable to be rejected without assigning any reason.
REFUND OF AMOUNT IS NOT PERMISSIBLE UNDER ANY
CIRCUMSTANCES.
10. Candidates who have applied under In Person Category, if failed to attend the
Convocation shall remit an extra Penal Fee Rs. 100-00 for sending the Degree
Certificate by Registered Post.
11. After the Convocation, the Degree Certificate Will be Sent to the eligible
Candidates (under In Absentia Category), only through Registered Post. If the said
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Degree Certificate is returned to the University undelivered, Candidates shall
remit an extra amount Rs. 100-00 to obtain the Degree Certificate.
12. If the Degree Certificate is to be sent outside India, an additional fee of Rs. 200-00
towards Postal Expenses is to be remitted along with the prescribed fee.
SPECIAL INFORMATION
01. The Information relating to the particulars of the Convocation will be notified in
News Papers and also at Regional and Study Centres of KSOU.
02. If N.C.L is not removed and class is not declared in the marks cards, such
candidates are not eligible to receive the Degree Certificate until they clear Lower
Examinations (N.C.L).
03. If there is any correction in the Original Marks Cards it may be correct
immediately before submitting the application for the Degree Certificate,
otherwise, student will be held responsible.
04. Students who passes in the Supplementary Examination just before the
Convocation are eligible only for Provisional Pass Certificate.
05. If the N.C.L is removed and class is declared in original Marks Cards of ICC &
CE students, they are eligible to receive Degree Certificate from Mysore
University.
NOTE :
i. Payment may be made through KSOU – 09 Examination Fund Challan or Demand
Draft drawn in favour of FINANCE OFFICER, KSOU Payable at Mysore.
ii. Payment by Cheque, Postal Orders or M.T. will not be accepted.
iii. Those residing outside Karnataka can submit the application by paying the amount
through KSOU-09 Examination Fund Challan in any State Bank of India Branch
or through demand draft.
iv. Those who are appearing for IMPROVEMENT EXAMINATION are not
suppose to apply for Convocation Certifiate.
FEE DETAILS
In Person Rs. 650-00

In Absentia Rs. 750-00
Search Fee per year of delay Rs. 50-00
From Book Post

Clerk
Examination Branch On India Government Service
Karnataka State Open University
Manasagangothri Degree / Subject : Roll No.
Mysore – 570006 (Karnataka) To,
Sri / Smt. ……………………………………..
………………………………………………..
………………………………………………..
………………………………………………..
…………….. Pin Code

KSOU Degree Requisition Form

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1

KARNATAKA STATE OPEN UNIVERSITY

Application for the Annual Convocation ……………………………………………

(Put a (√) against the column which ever is applicable)

IN PERSON (For Post-

Please write your Challan / DD No. and date

DD/ Receipt No. : ………… Rs. : ………………… Date : ………..…………

Date : ……………………… Place : ………………………….. Signature of the Candidate

Please write below your communication postal address legibly.

Sri / Smt. …………………………………….. Sri / Smt. ……………………………………..

Degree / Subject : Roll No. Degree / Subject : Roll No.

Office Use Only

Signature of the Officer

Declaration to be signed by candidate is detailed in this application. This should be invariably

INSTRUCTIONS TO THE CANDIDATES

In Person Rs. 650-00

From Book Post

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