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CONSENT FORM (FOR THE GARDUANDS)

Faculty/Department/College : Rajiv Gandhi South Campus (Barkachha)

FOR RECEIVING THE DEGREE / MEDALS

For The Session 2022-23

Sir/Madam,
I wish to attend the 103rd Convocation of the University in person.
Relevant information about myself is given below
Name of Student: AYUSH KUMAR

Name of Father: ARVIND DAS

Name of Mother: RENU DEVI

Course : B.Com. (Hons.)

Year of Passing : 2022-23

Examination Roll No : 20230BCO023

Enrolment No: 433516

panikapada, khetrajpur,
Full Address :
District: sambalpur, Pincode:768003

Email ID :(Present) ayush3340@gmail.com

Mobile No :(Present) 8249809997

Payment ID: order_N5OIPTZdai08RI

Student academic robs


200
charges convocation:

Payment Date: 27/11/2023

I shall report to the Faculty/Institute as per prescribed time schedule to


collect Uttaria and Safa (part of Academic Costume) on payment of
prescribed fee.

Date: 27/11/2023

Your faithfully
(Full Signature of the Graduand)
Note: Please submit the receipt at your faculty / Department / College for receiving the Uttaria and Safa.

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