Application Form for issue of Migration Certificate

to the Student

Name of Institution : ___________________________________________

Name of student : ………………………………………………….

Father’s Name : ………………………………………………….

Mother’s Name : ………………………………………………….

(Please attach copy of Secondary
School Examination Certificate)

Date of Birth : ………………………………………………….

Name of the Programme : ………………………………………………….

Batch : ………………………………………………….

Enrolment No. : ………………………………………………….

Year & Semester number : ………………………………………………….

Reason of Migration – successfully : ………………………………………………….

completed the course / withdrawal

Month/Year of qualifying Exams : ………………………………………………….

(Copy of final Grade Card/withdrawal
letter to be enclosed)

Details of Migration charges paid :

(Original copy of receipt to be
enclosed)

Signature of the student : ………………………………………………….

with date

The above facts have been verified.

(Name and signature of the Verifying Officer)

Recommended : ………………………………………………….
Name of HoI/HoD & Signature with date
and Stamp