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64 views3 pages

Form

Uploaded by

leela krishnan
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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For downloaded applications, kindly remit Rs.

50/- (Fifty only) through "Payment Gateway for students &


others" provided in the Online Remittance System in the University website.

Application No.:
(To be Filled by Office)

Application for obtaining Provisional / Extract Certificate


( For Degree / Diploma Examinations )
FOR OFFICE USE ONLY
DETAILS OF PAYMENT For D.D. Endorsement
(To be filled in by the candidate)
Name and place of the Bank Date:
D.D. Should be enclosed.
Register P No:
………………………………………….……………
Demand Draft No.: ……………………………….. Sl No:
Date of Payment : ………………………………..
Amount Rs.: ……………………………………….. Initial of the Asst.

Candidates should read the instructions very carefully before filling in the columns. Any column left
blank will cause delay in issuing of certificate.

1. Name as registered in the University Records }


(In Block Letters) } …………………………………………..

2. Sex : Male / Female

3. Date of Birth : …………………………………………...

4. Name of the Degree course Passed : ………………………………………..…

5. Last Appearance Register Number : …………………………………………….

6. Month & Year of passing the Final Examination : …………………………………………….

7. College in which last studied : …………………………………………….

8. Branch /Optional Subject Studied : …………………………………………….

9. If applied for 2nd Provisional Certificate the period } CRI From……………. To ……………..
Of C.R.I. to be mentioned here } At …………………………………………

10.Whether applied for convocation and received }


the degree or not (in person or in Absentia) If received, } …………………………………………….
state the date, month and year of convocation. }

10. Certificate for which applied for kindly tick[ 9 ] } 1. Provnl Cert 2. Extract of Convo
The column applicable } First.
Second

12. Address of the Candidate } …………………………………………….


(In Block Letters) } …………………………………………….
} …………………………………………….

Date: Signature of the Candidate

Endorsement of the Institution


Recommended towards issue of (Strike out whichever is not applicable) First/Second Provincial/ Extract of
convocation certificate as the candidate has passed / fulfill all the prescribed conditions as per the regulations of
this University to receive the Certificate.
Seal:
Date Signature of the Principal/ Dean

FOR OFFICE USE ONLY


i) Admission register P.No,.: ii)Certificate Issued Folio No.:
iii) Certificate Printed Machine No.:
iv) Signature:

Prepared by Read by Examined by :

CONTROLLER OF EXAMINATIONS.

DETAILS OF PASSING THE DEGREE / DIPLOMA EXAMINATION FOR WHICH THE CANDIDATE
HAS APPLIED FOR THE PROVISIONAL CERTIFICATE / CONVOCATION EXTRACT
This column should be filled in compulsorily by the candidate

Name of the Subject Reg.No. Month & Year of Name of the College / Marks
With Code Passing Centre Code Obtained

Place : ………………………….

Date : …………………………. Signature of the Candidate


INSTRUCTIONS

1. After conferment of a degree at a convocation. Provisional certificate will not be issued. But

only an EXTRACT from the convocation report will be issued based on the affidavit / Police

NOC produced by the candidate.

The fee should be paid through "Payment Gateway for students & others" provided in the
Online Remittance System in the University website. Postal orders and Money orders will
NOT be accepted.

2. A self addressed sufficiently stamped Registered cover should be enclosed for sending the

certificate by REGISTERED POST.

3. NOC of this University should be enclosed at the time of applying for IInd PPC for the CRI

transferred candidate of one recognised institution to another recognised institution.

4. A Xerox copy of H.S.C. mark sheet or equivalent certificate should be enclosed.

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