RAJIV GANDHI PROUDYOGIKI VISHWAVIDYALAYA (University of Technology of Madhya Pradesh) Airport Bypass Road, Gandhi Nagar, Bhopal- 462036 Application Form For Issue of Duplicate Migration/Provisional Degree Certificate Office use only. To, ae Duplicate Migration No. he Registrar, Duplicate Provisional Degree Né Fal Coat Proudyogikl Vihwavidaiy, Dept sre No, Stapal Dap Sir, Dealing Asstt. oi eet eee eee nee ogee aera a“ cea cee cciesiat nae ican va epee aie anes Migration/Provisional Degree Certificate ‘The necessary fee Rs. Bank has been deposited in Bank DraftiChallan No. of Dated 1 Full Name in English (In Capital Letters) Full Name in Hindi Enrollment No, Father's Name Examination last appeared/Passed Year Division/Grade Marks obtained in 8" semester Out of. Grand total (Including weight age) out of Branch Roll No, Name of the Institution Enclosures for Duplicate Migration/ Provisional Degree Certifieate 1 Demand Draft is payable in favour of Registrar, Raji or Bank Challan (U.B.L) Gandhi Proudyogiki Vishwavidyalaya, Bhopal 2. Original copy of Police F.LR. 3 inal Affidavit on Rs. 10/- Stamp Paper. 4. Final Semester/Year Mark sheet and TC. attested by the concerned Principal/Head of the Institution Fees: Duplicate Migration Rs. 500 Duplicate Provisional Degree Postal Charge Rs, 50)- extra Postal Charge Note :- Incomplete Application Forms will not be Entertained. Date ‘Your's Faithfully (Signature of Student) CERTIFICATE TO BE RECORDED BY THE PRINCIPAL/HEAD OF THE INSTITUTION, Certified that the eligibility for award of Duplicate Migration/Provisional Degree certificate has been checked with the office record of the institution ‘and found correct. The candidate may be issued the desired certificate Signature and seal of the Prineipal/Head of the Institution Postal Address = Postal Address = To, To, Name Name Clo Co Phone/Mobile No. Phone/Mobile No.