Requisition for issue of Multiple Copies of Transcript, Duplicate

Degree Certificate/Identity Card and Other Documents

Name ______________________________________________________________ Roll No. _____________________

Address ___________________________________________________________________________________________

________________________________________________________________________ Pin |___|___|___|___|___|___|

Contact No. __________________________ E-mail _____________________________________________________

Request for the issue of:

Tick as

Applicable Name of the Document

Fee in `̀̀̀

(Per Copy)

Copies

Required

Total

Amount Hard

Copy

Soft

Copy

Duplicate Degree Certificate* 500/-

Final Transcript 500/-

Semester Transcript 100/-

NoC Certificate (For Ex-students) 500/-

Provisional Certificate 500/-

N. A. Duplicate Identity Card 200/- N. A.

Character Certificate 200/-

Certificate of Verification

(Bona-fide/NoC/Equivalent) 100/-

Additional Fee of `̀̀̀ 100/- per document in case of soft copy required

Grand Total

Reason (Indicate briefly the reason for obtaining above document)

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

Certified that the information given above is correct and fee submission receipt is

attached herewith.

Place:

Date: Signature

* Copy of FIR should be enclosed for lose of degree certificate.

Note: You can collect the requested documents, in person, after 3 working days of receipt of duly filled

requisition form along with prescribed fee.

Received on Date __________________ Signature_________________________

Please fill the following if you are applying for a Bona-fide Certificate

Name _______________________________

Father’s Name _______________________________

Mother’s Name _______________________________

Programme BS-MS/Integrated Ph.D./Ph.D. Pursuing Since _____

Duration ______ Years

Present Address ___________________________________________________

___________________________________________________

___________________________________________________

Residing Since _______________________________

Permanent Address ____________________________________________________

____________________________________________________

Please submit one copy of passport size photograph along with this form

Dealing Assistant

Student’s Signature Department Office