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Roll No…………………..

(If received)

PANJAB UNIVERSITY, CHANDIGARH


Application for change of Examination Centre
________________________________________________________________________

A. Name (in capitals)…………………………… B. Fee remitted: Rs………………..


Rupees….………………………
………………………………………………. Bank Draft/I.P.O./University
Father’s Name………………………………. Receipt No……………………..
…………………………………
……………………………………………… Dated………………………......
________________________________________________________________________

C. (a) Name of Examination…………………..


(b) Name of the College/District (for private candidates) ……………………
.……………………
(c) Change sought: From………………………………………………………
To……………………………………..…………………
(d) Reasons for Change……………………………………….……………….
…………………………………………………………….……………….
……………………………………………………………………………..
________________________________________________________________________

D. Address for correspondence


……………………………………………… ……………………………
……………………………………………… Signature of the applicant
……………………………………………… Dated…………………..
________________________________________________________________________

E. Certified that the above particulars given by the applicant are correct.

Principal/Attesting authority who had attested the


Admission form (in case of private candidate)
Dated:…………………. Seal of Office
________________________________________________________________________________

F. (For Office Use)


1. Photos duly attested and signed have been/have not been received.
2. Provision for subjects offered by the applicant and accommodation at the
Centre asked for exist/do not exist.
3. The change of Centre from…………….….to ……..………………………
May/may not be allowed for the following reasons: ………………………
………………………………………………………………………………
………………………………………………………………………………

D.R.E./A.R.E. Superintendent Assistant/Clerk

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