Proforma 2

CONVOCATION FORM (IN ABSENTIA)

I regret to inform that owing to some unavoidable circumstances, I would be unable to attend the
second Convocation of The IIS University, Jaipur to be held on 7 December 2013. I, therefore, request
you to post my Degree Certificate to me at my residential address mentioned hereunder. I remit
herewith an amount of Rs. 1,000/- as the Fee for Degree.
Name, in full (in capital letters)
In English

..

In Devnagari script
(in Hindi)

..

..

..

Pin..

Email ID

..

Phone No.

Landline (with Area Code) ......

Residential Address

Mobile.
Name of the Exam for which Degree Certificate would be issued : ...
Mode of Payment: [Please tick () in the relevant column]

By Cash
Vide DD No. . Dated .. Drawn on ...
in favour of The IIS University, Jaipur
Online (by Credit/Debit Card) :
visit http://iisuniv.ac.in/content/convocation-registration-form

Signature