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Convocation Application Form

This document is an address and no dues verification form from the Directorate of Distance Education at SRM Institute of Science and Technology. It requests information from a student such as their name, register number, date of birth, gender, degree/diploma details, branch, and contact information. It also has sections for the student and head of institution signatures and notes that the form will not be accepted without a color photo affixed. The form is verifying the student's address and checking that there are no outstanding dues before presumably allowing participation in further education activities.

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MohanrajRajangam
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123 views1 page

Convocation Application Form

This document is an address and no dues verification form from the Directorate of Distance Education at SRM Institute of Science and Technology. It requests information from a student such as their name, register number, date of birth, gender, degree/diploma details, branch, and contact information. It also has sections for the student and head of institution signatures and notes that the form will not be accepted without a color photo affixed. The form is verifying the student's address and checking that there are no outstanding dues before presumably allowing participation in further education activities.

Uploaded by

MohanrajRajangam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SRM INSTITUTE OF SCIENCE AND TECHNOLOGY

(Deemed to be University u/s 3 of the UGC Act,1956)

DIRECTORATE OF DISTANCE EDUCATION

ADDRESS & NO DUES VERIFICATION

Register No : Date:
Name of the Candidate as entered in
the University records:(in Capital
Letters)
Register Number Date of
(Last Appearance) Birth
Year of Admission Month Year
Duration of the Course

Gender Male/Female/ Transgender

Name of the Degree/Diploma

Branch
Subject /Specialization
Name of the College and Year of study
Month &Year of Appearing the Final
Examinations
Mention Year or Semester pattern

Communication Address

Mobile Number
E-mail (pls. Write in Clear)
Note: Application forms will not be accepted under any circumstances if color photo is not affixed .

Office Purpose

NO Dues :

Accounts Section :

SIGNATURE OF THE STUDENT SIGNATURE OF


THE HEAD OF THE INSTITUTION

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