jk"Vªh; izkS|ksfxdh laLFkku iVuk / NATIONAL INSTITUTE OF TECHNOLOGY PATNA

शिऺा मंत्राऱय,भारत सरकार के अधीन एक राष्ट्रिय महत्व का संस्थान/ An Institute of National Importance under Ministry of Education, Govt. of India

अिोक राजऩथ, ऩटना – 800005, बिहार/ ASHOK RAJPATH, PATNA - 800005, BIHA
__________________________________________________________________________________________________
(EXAM SECTION)
REQUEST LETTER CUM DOCUMENT ISSUE FORM
To,
The Professor-in-Charge (Exam)
NIT Patna
I am a bonafide student of NIT Patna and requesting you to kindly provide me the following tick
marked (√) the document(s). The details are given below:

Grade Card Original / Duplicate

Provisional Certificate Original / Duplicate
Transcript First Copy / Additional Copy No. of additional copies

Check list of photo copy of documents attached:-

A. For Issue of Grade Card (Provide following as applicable)
1. Photo ID Proof 2. Final Semester provisional grade card (UG/PG) 3. Semester registration
slips (Ph.D.) 4. Authority Letter / Email (if needed) 5. FIR Copy/Affidavit for Duplicate Grade
Card (in case of loss) 6. Payment receipt of Rs. 1000/-(for issue of duplicate grade card).
B. For Issue of Provisional Certificate (Provide following as applicable)
1. Photo ID Proof 2. Consolidated Grade card 3. Due Status from department / Library /hostel
(as applicable) 4. Authority Letter / Email (if needed) 5. FIR Copy/Affidavit for Duplicate
Provisional certificate (in case of loss) 6. Payment receipt of Rs. 1000/-(for issue of duplicate
Provisional certificate).
C. For Issue of Transcript
1. Photo ID Proof 2. Consolidated Grade card 3. Payment receipt for first copy (Rs. 500/-) and or
additional copies (Rs. 100/- each) 4. Authority Letter / Email (if needed)
D. For dispatch of documents (if needed):-
(i) Payment receipt of Rs.150/- (as a postal charge for Inland)
(ii) Payment receipt of Rs. 1500/- (as a postal charge for Abroad)
E. Payment link:- http://exam.nitp.ac.in:9001 , Miscellaneous Fee Payments
It is certified that all the documents and information provided are true and correct.
Program: (UG/PG/Ph.D.) Roll No.: ------------------- Name of the student:-----------------------------------
Branch:-------------------------- Email Id &Contact Number------------------------------------------------------
Postal Address (If document to be dispatch)
Signature with Date and time:
(For Office use only)
Handed over the following Documents after verification
1……………………Certificate No……………
2……………………Certificate No……………
3……………………Certificate No…………… (Staff Sign with date)