Form No.

12

ASSIGNMENTS REMITTANCE -CUM-ACKNOWLEDGEMENT CARD

Enrol. No._____________
Programme Title: ________________

INDIRA GANDHI NATIONAL OPEN UNIVERSITY

ASSIGNMENTS REMITTANCE -CUM-ACKNOWLEDGEMENT
CARD

Name : __________________________________
Course Code: ______________Medium:
_______
S.No.

Enrol. No._________________________

Programme Title: _______________

Name : ___________________________

Medium : _____________________

Course Code: _____________________

Assignment No.

S.No.
For Office Use Only

S.No. ___________________________

S .No. ___________

Signature of the recevier ____________

Date of Receipt: ____

Name of Evaluator: _
Signature of the Student
Date : _____________

Date of despatch to
the Evaluator:
________________

For Office Use Only

Assignment No.

Date : ____________

Seal

Signature of the Student

Name : _______________________

Date of receipt from

the Evaluator:
_________________

Address of the Student : ________________________

Date : _____________
(Please write your complete address and affix adequate postal stamp on reverse)

Affix
Stamp
Here

From:

To
The Coordinator
Study Centre concerned

(ADDRESS OF THE STUDENT)

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