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Form No.

_______________

UNIVERSITY OF MALAKAND
Registration for Convocation, 2016
Name (as per University Record):_____________________________________
Fathers Name: ___________________________________________________
UoM Registration No.______________________________________________
Name of Degree/Program: ________________________________Year of Passing:_______________
UoM Bank Receipt/Bank Draft No.________________________ for Rs. 2000/- Dated: ___________
Phone. _____________________ Cell No. __________________Email: _______________________
Permanent Address: _________________________________________________________________
__________________________________________________________________________________
Mailing Address: ____________________________________________________________________
__________________________________________________________________________________
I have Deposited /Not Deposited my original degree of ______________having serial No. _________
I shall abide by the rules and all instructions regarding the convocation.
(Please Tick () the relevant and cross (X) the other)

Candidates Signature
Dated: ___________
Countersigned by

Head, Concerned teaching Department

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