RAJASTHAN TECHNICAL UNIVERSITY

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Phone: +91-0744-2473014, 2473106, 2473063, 2473861
APPLICATION FOR DUPLICATE MARKSHEET(S)

COURSE B.Tech. M.Tech. MBA MCA BHMCT B.Arch. MAM

Roll No……………………………… Enrollment No……………………………….Branch……..…………

Name…………………………………………………………...……………………..…………………………..
Father’s Name………………………………………..…………….……………………...…………………….
Mother’s Name…………...……………………………………………….………………..……………………
College……………………………………………………………………….………...…………………………

Choice For Delivery of Document (Please Tick  Mark) :- College Residence

PAYMENT DETAIL:- Challan/DD No……………………………...……..…Date…………………..……….
Bank Name………………………………………..……………….…….………Amount………………….……

Home Address :-…………………………..……...……………………………………………………………...

………………………………………………………...…………………………………………………………..
…………………………………………………………………………………Pin Code…...…………………..
DETAILS OF DUPLICATE DOCUMENT REQUIRED:-
1. ……………………………………………… 4. ………………………………………………
2. ……………………………………………… 5. ………………………………………………
3. ……………………………………………… 6. ………………………………………………

Check List :
1. Photocopy of Mark Sheet Mobile No.
2. Demand Draft/Challan E-Mail ID
3. Photocopy of Personal ID
4. Demand Draft of Rs. 350/- for each Mark sheet. Demand Draft should be in favour of Rajasthan
Technical University, Kota payble at Kota in original.
5. Photocopy of Residence Proof (If delivered at residence)
6. One A4 size self addressed envelope Signature of Candidate with full name

Note :-
1. All attached photo copies of documents should be self attested and properly legible, otherwise
document(s) will not be prepared.
2. In case of any wrong information provided in the form, candidate will be fully responsible for the
same and University may take appropriate action against him.

For Office use only

Reference No. ……….……… Date……..……… Dispatch No……..………… Date……...……

Address :- Office of the Controller of Examination, Rajasthan Technical University, Rawatbhata Road,
Kota-324010