Registration Form

Name of the Applicant

Date of Birth

Gender

Blood Group

Email

Phone

Alternate Phone

Father's Name

Mother's Name

Guardian's Name

Course Applying for

Reservation sought in

SC

ST

Address

Permanent/Current Address

City

State/Province

Zip/Postal

Country

Academic Career

10th School Name

10th Board

10th Max Mark

10th Mark Secured

10th Percentage/Division

12th School/College Name

12th Board

12th Max Mark

12th Mark Secured

12th Percentage/Division

+3 College Name

+3 Board/University

+3 Max Mark

+3 Mark Secured

+3 Percentage/Division

+3 Honours Subject

+3 Honours Max Mark

+3 Honours Secured Mark

+3 Honours Percentage/Division

Payment

Online payment of Rs.600/- through UPI/ Debit/ Credit Card/ Net Banking in favor of

Controller of Finance
Khallikote Unitary University
Central Bank Of India, 
Account No: 5132400923
IFSC Code: CBIN0283241

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DECLARATION AND UNDERTAKING BY THE APPLICANT

I submit myself to the jurisdiction of the authorities of the Khallikote Autonomous College and declare that I shall abide by the rules and regulations. The decision of the authorities of the University about my merit position shall be binding on and acceptable to me. I hereby declare that the particulars stated by me in this application and elsewhere are true. I have read the Information Brochure and satisfied myself with the fact that I fulfill all the admission eligibility requirements, I understand that in the event of my being found ineligible even at a later date, my selection/admission will be cancelled I further undertake that I will not involve in any ragging activities in the University and hostel premises. I understand that criminal case will be filled against me if I indulge in ragging.