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GONDWANA UNIVER'ITY, GADCHIROLI


lEstablished by Government of Maharashtra Notification No.MISC-2OLO/1252/1O]UNl -4 Oated 27rh Sept.2011
State University Governed by Maharashtra University Acl,19941

IEXAMTNATION SECTTONI

DIRECTOR,
BOARD OF EXAMNINATION & EVALUATION
GONDWANA UNIVERSITY,GADCHIROLI

Subiect: Application for Duplicate Marksheet.


Sir,
Kindly issue me Duplicate Varksheet as per my details grven below.

1l Full Name : [As per U niversity record]

2l Mother's Name:
3l Name Of Examination: Roll No: Sum/Wint
Roll No. S umlWint
Roll No: Sum/Wint
4lName Of the College:

5l Name Of the Centre/Centre Nc.


6lNumber Of total 5u bje cts Tota I Papers; Result: Pass/Fail

TlWhether applied/Passed in revaluation : Yes/ No

8lReason of applying for Duplicate Marksheet :

9l Affidavite on Rs:100/- Stamp Paper [Self Declaration]

101 University Cash Receipt No, .

Date: lAmount Rs:110/- Per Copy]


1-11 Enclosed : Xerox Copy Of Ma rksheet,Affidavite

l2lPermanent Address with Pin code No:

Srgnatu re Of St ude nt
Name:

Pin Code:
Mobile No.:

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