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
Hard
Soft
Copy
Copy

N. A.

Name of the Document

Fee in `
(Per Copy)

Duplicate Degree Certificate*

500/-

Final Transcript

500/-

Semester Transcript

100/-

NoC Certificate (For Ex-students)

500/-

Provisional Certificate

500/-

Duplicate Identity Card

200/-

Character Certificate

200/-

Certificate of Verification
(Bona-fide/NoC/Equivalent)

100/-

Copies
Required

Total
Amount

N. A.

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

_______________________________

Fathers Name

_______________________________

Mothers 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

Students Signature

Dealing Assistant
Department Office