You are on page 1of 2

DR.

BALASAHEB SAWANT KONKAN KRISHI VIDYAPEETH,
30th CONVOCATION

(Please read instructions before filling the form)

To,
The Registrar,
Dr. Balasaheb Sawant Konkan
Krishi Vidyapeeth, Dapoli,
Dist. Ratnagiri.

Sir,
I wish to attend the convocation to receive my Degree of _________________
(Examination)
in person Tick as
in absentia 

My particulars are as follows :
Name in full (in block letters as per transcript issued by the university)

(Surname) (Name) (Middle Name)

Sex Male Female

Degree Examination Passed in the Month ___________ Year _____________________
Regd. No. _______ Name of College __________________________________________

Class awarded First Class with Distinction / First Class / Second Class

Post Graduate Degree Examination Passed in the Month _______ Year ____________
Regd. No. _______ Name of College __________________________________________
Discipline ________________________________________________________________

Class awarded First Class with Distinction / First Class / Second Class

Doctoral Degree Examination Passed in the Month ______ Year ___________________
Regd. No. _______ Name of College __________________________________________
Discipline ________________________________________________________________

Class awarded First Distinction/First Division/Second Division/By Research

(Copy of transcript enclosed)
[P.T.O.]

___________________________________ Tal.________________________________Post. Candidates who seek admission to more than one Degree at the same Convocation must submit a separate application and pay separate fee in respect of each Degree. Balasaheb Sawant Konkan Krishi Vidyapeeth. Registrar Demand Draft Rs. . Registrar INSTRUCTIONS 1. _____________ Date ______________ Address for correspondence (Degree Certificate will be sent on this address) Name _____________________________________________________________ At. The fee for admission to the First / Second Degree of this University is Rs. __________________________________ State _______________________ Tel / Cell No. Dapoli. Dy. 250/. The student should send the prescribed Convocation fee by demand draft in the name of the Dr. _________________________________ Place ______________________ Date _______________________ Candidate’s Signature (Entries to be made by the University Office) Result Checked by : Degree Certificate Checked by : Dealing Assistant Supdt.(in absentia) and Rs. I have read the notes overleaf and accordingly I remit the prescribed fee of Rs. Dist. 2. Incomplete forms and those received after the expiry of the prescribed date will not be considered. _______________ Date _____________ Degree Certificate issued by in person / sent by post on ______________________ Dealing Assistant Supdt. 250/100 (Two hundred fifty / Hundred only) by Demand Draft No._______________________________ Dist. Dy. Ratnagiri and payable at Dapoli 3. 100/. _____________ No.(in person).