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A stamp size

colour photograph
of the candidate to
be affixed

Personal Information for


Receiving Bonafide Certificate

1. Name ------------------------------------------------------------------- ,

2. Son/Daughter of MR/MRS. -----------------------------------------------------------------------------------,

3. Permanent Address --------------------------------------------------------------------------------------------------

---------------------------------------------------,

4. Course Name : B. Tech/M. Tech/Ph.D. Degree programme ________________________

5. Department ----------------------------------------------------------------

6. Admitted during the session ------------------------------------.

7. ID No. ___________________

8. Boarder of -------------------------------------------------------------------- Hostel/Day Scholar

I declare all the information provided above are true to best of my knowledge and belief.

__________________________________

(Full Signature of the Student)

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