APPLICATION FOR PROVISIONAL CERTIFICATE/ORIGINAL CERTIFICATE/TRANSCRIPT
To,
The Controller of Examinations Photo
Sir,
I may kindly be issued a Provisional Certificate/ Original Certificate/Transcript
1. Name (in Block letters) : __________________________________________________________
2. Registration No. with year: ________________________________________________________
3. Name of Examination & Year : ____________________________________________________
4. Year of Passing : ________________________________________________________________
5. Roll No. : ______________________________________________________________________
6. Name of the College/Department: __________________________________________________
7. Class/ Division & Rank, if any: ____________________________________________________
8. Number & Date of the Instrument of payment fee: _____________________________________
9. Specialization paper (if any) : ______________________________________________________
10. Complete mailing Address : _______________________________________________________
With Mobile number, if any
_______________________________________________________
11. CGPA: _________________
12.
Date: Signature of the Applicant
For College/Department Use only
The particulars submitted by the applicant, who was a student of this College/Department, have been
verified. He/she passed the examination as stated above in the year ____________ and qualified for the
degree. The certificate/transcript may be issued to him/her.
(Signature of the Principal/Head of the Department with
Date & Seal)
* Attested Photocopies of Admit Card, Grade Card(s) and Registration No. must be enclosed with this
application form. See the Rules given overleaf.
For University Office use only
Particulars Verified & found correct. Amount for fee received. May be put up issue of Provisional
Certificate/Original Certificate/Transcript.
Signature of Dealing Assistant
Date & Issue No:
Section Officer, Certificate Branch Joint Registrar
RULES
1. All applications must be forwarded by the Principal of the College/ Head of the Department from
which the candidate passed.
2. An attested copy of Final Admit Card, University Registration No. and Grade Card of all four
semester examination must be enclosed.
3. One Passport size photograph with name & Roll No. at the backside of the photo.
4. In case of other examinations, an attested copy of Admit Card, University Registration No., Grade
Card and Course Completion Certificate from the Head of the Institution must be enclosed.
5. Certificate/Transcript will be issued to the candidates only.
6. Fees for various Certificate are as shown below:
a) Rank Certificate: Rs. 300/-
b) Provisional PG Certificate: Rs. 300/-
c) Provisional PG Diploma Certificate: Rs. 300/-
d) Provisional Degree Certificate: Rs. 300/-
e) Provisional B.Ed. Certificate: Rs. 300/-
f) Transcript: Rs. 300/-
g) Provisional Diploma Certificate: Rs. 400/-
h) Original Certificate of M.Phil/Ph.D.: Rs. 1200/-
i) Original Certificate PG/M.Ed. Certificate Rs. 700/-
j) Original Degree/B.Ed. Certificate: Rs. 500/-
k) Original PG Diploma/Diploma Certificate : Rs. 400/-
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