Rajarshi Janak University
Central Examination & Record Centre

Examination Form

Faculty/Institute
Name of Campus
Previous Roll No.
Registration No
- - - -
Sex:
Full Name
Full Name In Nepali
Nationality
Date of Birth According to S.L.C./S.E.E.
Father's Name
Mailing Address:- Province
District
Rural Municipality/Sub Metro/Metro
Ward No
Tole
Examination Passed:
Examination Board/University Year Roll No. Division
SLC
Intermediate
Bachelor
Others
If Appeared in this examiation priviously mention:
Year
Roll No.
Year
Roll No.
Year
Roll No.
Year
Roll No.
So far as I am convinced the particulars furnished above are correct. The office of the Controller of Examinations have not taken any action against me debarring from this examination. If found false, any action to be taken against meby the Controller of Examinations shall be acceptable to me.

नोट:

(क) विधार्थीको दस्तखत हाजिरी अनुसार नमिलेमा परिक्षाफ़ल प्रकाशित गर्न परिक्षा नियन्त्रण कार्यालय बाध्य हुने छैन।
(ख) समुह र पठ्यांस स्पस्ट खुल्ने गरी विषय उल्लेख गर्ने।
( ग ) परिक्षा फर्म परिक्षार्थि स्वयंमले भरेको र भरेको विवरण अनिवार्य रुपमा साँचो हुनु पर्ने छ।
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