Application Proforma

Application form for one time proficiency test for PGDCBR, DCBR, add-on courses for regularization of registration in CRR of students passed out from the studies centers recognized by Bangalore University from 2004-05 to 2014-15 session. Last Date of Application is 20th May 2024

Scanned Recent Coloured Passport Size Photograph in.jpg/jpeg
format size below 1 MB.
Click Here to Upload

Student Full name *

Father's name *

Mother's name *

Date of Birth *

Gender *

Nationality *

Aadhaar Number *

Category *

whether belongs to PwD *

Do you belong to EWS category *

Permanent Address *

Address *

Village/City *

State *

District *

Pin code *

Correspondence Address same as Permanent address

Correspondence Address *

Address *

Village/City *

State *

District *

Pin code *

Email Id *

Mobile number *

Details of course underwent from Bangalore University

Course *

Specialization *

Have you registered with RCI or earlier applied for registration (Yes/No) .

yes no

Academic session *

Name of Study Center *

Enrollment number of the course *

Year of passing *

Total Marks of the course *

Total Marks obtained *

% Percentage *

State for Exam center *

upload documents:

1.Student Signature ( Put your Signature on a Blank white paper A4 size and scan your Signature and save it .jpg/.jpeg not more than 150 pixel ) *Click Here to Upload

2.Self attested copies of marksheet and passing certificate issued by Bangalore University to be uploaded in single pdf file, size not more than 2 MB. *Click Here to Upload

Enter the text image. *

I hereby declare that all the information and documents furnished by me is true and correct to the best of my knowledge and belief. In the event of any information being found incorrect or misleading, my candidature shall be liable for cancellation for appearing in the proficiency test by the NBER, RCI.