RAJIV GANDHI PROUDYOGIKI VISHWAVIDYALAYA, BHOPAL. (University of Technology of Madhya Pradesh) ane Se Airport Bypass Road, Gandhi Nagar, Bhopal-462036 === Application Form For Issue of Duplicate/Corrected Mark-Sheet | Pte To, Duplicated Mark Stet Recent Passport ‘The Registrar, Makshest No size Photograph R.G.P.V., ‘Dispatch No, Duly attested by at Direetor/Principal es een ‘With seal oe sling Ast 1 Enrolment No. have been a Student of ti is Universi studying as Regular/Ex student in (College) and passed the Division. I request you to in the Month and Year kindly issue me a Duplicate/Corrected Mark-Sheet. The necessary fee Rs. has been deposited in Bank Draft/Challan No. « of Bank ____Date 5 1. Name of the Examination for which Mark-Sheet is required Course 2. Name of the Semester in which you are currently studying 3. Branch ______ Roll No ———__—- Enrolment No_______ 4. Please fill for Corrected Marksheet / Duplicate Marksheet Requires Candidate Name (Capiat er) [Father's Name (Capitattewey | Mother’s Name (Capit tater) ‘As Per Masso] Corrected Name | AS Fer Naishet ‘AsPerMayisieet | Corrected Name ware) Aster Mariset (arc) (ware) [As Per Marshet {HSCAISSC). IMISCITISSC) aH 2) a a @. Please fill only those Semeste set / Corrected Marksheet Required: en | Monk Stara tnan Mats Co Saks Oceed | Sem Mok Aero Ean | Nz OAT T Lv =a x] i VI x Gr Vir - Ov Vu Enclosures for Duplicate Mark Shect/ Corcectsd_ Mark Shect: (1) Demand Draft is payable in favour of Revistrar, R.G.P.V., Bhopal o Bank Challan (U.B.1). @) Original copy of Police E.I.R, omy for Duplicate Mark Stet G) Original Affidavit on Rs.10/- stamp paper. for tu) (4) tested photograph (by Director?Principal of Insitute) should be affixed. For bab) (5) Original Mark-Sheets in which Correction requited. (ny for Crreced Mark Stet) (6.) _Attested photo-copy of X" & XII" Mark-Sheet. For both) 7.) Attested photocopy Admission Slip of Counseling ECCA/ DTE/CLC. (Onl for Same Correction Eeesi: . Duplicate/Corrected Mark-Sheet Rs, 100/- per Mark-Sheet ‘Yours faith fully Postal Charge Rs, 50/- Extra Note :-Incomplete Application Forms will not be Entertained. jgnature of Student Date /_ 200. (with Name) Postal Address:- Postal Address:- To, To, Name: Name: Clo Clo: Pin... Pin... Phone / Mobile No. Phone / Mobile No.