Reg (E) Form No.

39 dated: 17/10/206

Rajiv Gandhi University of Health Sciences, Karnataka

4th 'T' Block, Jayanagar, Bangalore - 560 041

Registrar (Evaluation)

Ph: 080 26961930 Fax: 080-26961931

APPLICATION FOR:
A) DUPLICATE DEGREE CERTIFICATE
1

B) NAME CORRECTION IN DEGREE CERTIFICATE

Full Name of the candidate in block letters

as registered for the University examinations
Gender
Register Number
Course & Year of passing (Month & Year)
Phase Part I or Part II to be mentioned
clearly.

2
3
4

5
6

College from which appeared

Correct postal address to which certificate
has to be sent (in block letters with pin code)

Whether the prescribed fee

remitted? If so furnish details

Place: Secaucus ,USA

Date :
/ /2015

has

PATEL VAIBHAV DIPAKBHAI

Male
03P6423
B.PHARM
OCTOBER 2007

Female

SONIYA EDUCATION TRUST's COLLEGE OF PHARMACY

C/O Dr.DIPAKBHAI PATEL
B/7 MAKANJIPARK SOC-2,
B/H BALASHRAM,
KATARGAM ROAD, SURAT 395004

been

Challan No.
Date:
Bank:
Ph No: +91-9979261997
Mobile: +1-551-208-5652

Amount:

Signature of the candidate

The information furnished by the candidate as above is correct as per the records maintained in the college.

Please tick the documents submitted:

Principal

All payments shall be made by Challan [Form No.2] in favour of Registrar [Evaluation],
RGUHS, Bangalore
A. DUPLICATE DEGREE CERTIFICATE:
1.
2.
3.
4.

B. NAME CORRECTION IN ALL DEGREE

CERTIFICATES:

Acknowledgement for having lodged Police

complaint.
Affidavit on Stamp paper of Rs.20/- signed by a
Notary.
Photo copies of all year marks cards and
Internship/Training Certificate attested by a
Gazetted Officer.
Two Passport size photos.

1.

Original Degree Certificate

2.

Photo copies of all year marks cards and

Internship/Industrial Training Certificate

Fee Details for Name Correction

All Degree (Indian/Foreign)

Fee Details for Duplicate Degree Certificate

UG Absentia (Indian)
2,000/UG Absentia (Foreign)

4,000/-

PG Diploma in person/Absentia (Indian)

3,000/-

PG Diploma in person/Absentia (Foreign)

4,000/-

PG Degree (Indian)

5,000/-

PG Degree (Foreign)

7,000/-

Super Speciality / Ph.D / Fellowship

6,000/-

Certificates Course

3,000/-

Note: To receive any document from RGUHS in person Identity Card is mandatory.

Rs.500/-