Rajasthan Technical University, Kota

jktLFkku rduhdh fo'ofo|ky;]dksVk

Phone: +91-744-2473861 Fax: +91-744- 2473931

APPLICATION
FOR

DUPLICATE MARKSHEET(S)/PROVISIONAL DEGREE

COURSE:

B.Tech M.Tech MBA MCA BHMCT

NAME: ROLL NO:

FATHER’S NAME: MOTHER’S NAME :
COLLEGE:

NAME AND YEAR OF EXAMINATION:

PAYMENT DETAILS: D/D NO. DATED: AMOUNT

CHECK LIST:
1 PHOTO COPY OF MARK SHEETS (if available)
2 DEMAND DRAFT
3 PHOTO COPY OF PERSONAL ID

MOBILE NO. SIGNATURE

EMAIL ID:
ADDRESS:

(for office use only)

REFERENCE NO: RECEIPT DATE:
DISPATCH NO: DISPATCH DATE:
REMARKS :

Address: Rajasthan Technical University, Rawatbhata Road, Kota -324 010