th

10th CONVOCATION on Thursday November 8 2012, 1:00 PM

REGISTRATION FORM
(Strike off which is not applicable)

To,

Dr. R.M.Patrikar
Dean (Academic)
Visvesvaraya National Institute of
Technology, South Ambazari Road,
Nagpur 440 010

Sir,
I hereby confirm my participation in the 10th CONVOCATION of VNIT, Nagpur scheduled on on Thursday

November 8th 2012, 1:30 PM, for receiving my UG / PG / Ph.D./ M. Tech.(by research) degree in person. My
particulars are as under.
1. Name :

_______________________________________

(As per mark-list)

2. Name of the Course :

_______________________________________

3. Final Year/Sem Exam. Roll No

_______________________________________

4. Enrolment No. :

_______________________________________

5. Year of passing examination :

Summer 20012/ Winter 2011

Yours truly,

(Signature of Student)

Place : ______________
Date : ______________