` 10.00
MZU/Ex/XX(A)
Sl. No. …………
MIZORAM
UNIVERSITY
AIZAWL
Application Form for Re-Scrutiny of Answer-script(s)
1. Name of the applicant
(In block letters)
2. Registration No.
:
………………………………………………………………
:
……………………………………………………………………
3. Complete Postal Addres s
:……………………………………………………………………………
with phone/mobile no.
:
……………………………………………………………………
4. Particulars of Examination in which appeared,
Name of Exam
Year / Semester
5. Subject(s)
Roll No.
Name of College/
Department
Category, i.e
Regular / Repeater
Paper(s) in which
Re-Scrutiny is desired
Marks Obtained
………………………………………..
……………………………..
……………………..
………………………………………..
……………………………..
……………………..
……………………………………….
……………………………..
……………………..
6. Details of Fees:
Bank Draft / Challan No. & Date
Amount
………………………………………
`……………………………………..
7. Specimen Handwriting:
(Please write a few lines in the language in which answers have been written in answer-script)
……………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………..
DECLARATION
I, ……………………………………………… Son/Daughter of………………………………………….
hereby declared that the result of Re-Scrutiny shall be binding upon me.
Date …………………………….
Note : Fee payable for Re-Scrutiny :
Signature of the Candidate
`. 320/- per
paper