Roll No : ______________

Application for obtaining the Degree in Convocation either in Presentia / Absentia *

Recent passport
To, size photograph
The Deputy Registrar of the candidate
(Examination)

Sir,

I hereby apply to get my Degree certificate at the convocation to be held in ____________.

I am furnishing hereunder the required details and I want to receive Degree certificate
in Presentia / Absentia.

1. Name of the Candidate

2. Roll No.

3. Name of Programme

4. Name of Institute
5. Permanent Corresponding Address:

Full Name :

Society / House :

Area / Street :

Taluko : District :

State : Country :

Phone: (R) (M)

Pin code :

Email ID :

Declaration

I hereby undertake that

1) I know that as per Regulation, as and when I ful-fill all the academic requirements, in the concerned
programme, then Degree will be awarded to me.
2) The information furnished above is true and correct. If any discrepancy is found and due to that any problem
arises then it would be my responsibility.

Date : / / Student's Signature :

* Strikeout whichever is not applicable.

Certified that the above student has paid Rs.xxxx as convocation fee along with the tuition fee

Name and Signature of Office Superintendent