THANTHAI PERIYAR GOVERNMENT INSTITUTE OF TECHNOLOGY,

VELLORE – 632 002

Application for Transfer Certificate/Conduct Certificate

01. Name of the Student :

(IN BLOCK LETTERS)
02. Date of Birth :

03. Class and Branch :

04. Roll No. :

05. Register No. :

06. Name of Father :

07. Address for Communication :

08. Nationality :

09. Religion :

10. Caste and Community :

11. Scholarships, if any received :

12. Date/Year of Admission :

13. Date/Year of Leaving :

14. Reason/Purpose for which T.C. is Required :

15. Whether ‘NO DUES’ certificate is produced :

16. Signature of the Student with date :

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DEPARTMENT USE ONLY
01. Last date of Attendance :
02. Conduct & Character of the Student :
03. Signature of Head of Department :
_____________________________________________________________________
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NO DUES CERTIFICATE
01. Department : 7. All Labs
02. Library :
03. Physical Director : 8. Exam cell
04. NSS :
05. Hostel :
06. Office :
_____________________________________________________________________
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OFFICE USE ONLY

T.C. No. issued on